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Measles, or rubeola, remains a highly contagious infectious disease with a concerning resurgence in the United States. Despite previous control efforts, the number of reported cases continues to rise, surpassing the total for the previous year in just the first quarter of 2024 (CDC, 2024a). Emergency nurse practitioners and other emergency clinicians are likely to encounter patients presenting with concerns of or exposure to measles. However, given the low frequency of cases in the past, many emergency clinicians have likely not previously encountered measles, making identification more challenging. Early recognition and isolation are paramount in containing the spread of this virus and mitigating potential complications. This article aims to provide a review of measles, covering its pathophysiology, clinical presentations, and recommended management strategies for suspected or confirmed cases in emergency care settings. [ABSTRACT FROM AUTHOR]

Measles is a vaccine-preventable illness. Nevertheless, in recent years, measles is still endemic and epidemic in both the developed world and the developing world. The public perception of measles in the past was that it was not a big deal. However, measles is associated with a number of complications which can be places in three categories which are: acute(diarrhea, otitis media, pneumonia, encephalitis, seizures, and death) and delayed-subacute sclerosing panencephalitis (SSPE) and post-measles immune amnesia. Contrary to the beliefs of the anti-vaccine lobby, measles is bad. In acute measles, the death rate is 1–3 per 1000 and the risk of encephalitis is 1 per 1000. Relatively recent investigations indicate that SSPE is considerably more common than previously believed. The worldwide contribution of post-measles immune amnesia to morbidity and mortality is likely to be huge. In exposure situations, two doses of measles vaccine will prevent 99% of cases. Presently in the United States, the first dose is given at 12 through 15 months of age. The second dose is most often administered at 4 through 6 years of age. In my opinion, the second dose of measles vaccine should be given 4–6 weeks after the first dose rather than at 4–6 years of age. Children who don't have antibody to measles should not travel to risk areas. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to explore the spatial and temporal characteristics of emerging airborne viral infectious diseases outbreaks worldwide. Subject and methods: We conducted a systematic literature review on outbreaks of emerging airborne viral infectious diseases and calculated outbreak number and intensity at the country level. Fisher's exact test was used to compare the viral infectious diseases outbreaks in different income-level regions. To identify the major airborne viral infectious diseases outbreaks, we ranked and extracted the leading viral infectious diseases in outbreak number and intensity in each country by year. Results: A total of 2505 outbreaks were reported from 1873 to 2021 across 2010 studies. There were 47 countries (47/130, 36.15%) with more frequent emerging airborne viral infectious disease outbreaks (more than nine outbreaks), and these countries mainly distributed in high-income regions (22/47 countries, 46.81%, p < 0.05), especially in Western Europe (14/47 countries, 29.79%, p < 0.05). The number of overall outbreaks was more in the United States and China than in other countries in different years. Outbreaks of measles and influenza are always frequent and intense. Highly pathogenic human coronaviruses infection caused short-term pandemics during which their outbreak number and intensity exceeded other viruses. Rift valley fever outbreaks in the human population are spreading outside of Africa through the flow of goods and travelers. Conclusion: Countries in high-income regions reported more emerging airborne viral infectious diseases outbreaks, especially in the Western European region, the United States, and China. It is urgent to strengthen collaborative surveillance of emerging airborne viruses, cross-border flow of goods and travelers, and ecological environment to avoid the spread of viral infectious diseases outbreaks worldwide. [ABSTRACT FROM AUTHOR]

Measles is one of the most contagious respiratory diseases in the world that has the potential to be life‐threatening. It is caused by a virus and is still common in many countries. [ABSTRACT FROM AUTHOR]

Ongoing outbreaks of measles threaten its elimination status in the United States. Its resurgence points to lower parental vaccine confidence and local pockets of unvaccinated and undervaccinated individuals. The geographic clustering of hesitancy to MMR indicates the presence of social drivers that shape parental perceptions and decisions on immunization. Through a qualitative systematic review of published literature (n = 115 articles; 7 databases), we determined major themes regarding parental reasons for MMR vaccine hesitancy, social context of MMR vaccine hesitancy, and trustworthy vaccine information sources. Fear of autism was the most cited reason for MMR hesitancy. The social drivers of vaccine hesitancy included primary care/healthcare, education, economy, and government/policy factors. Social factors, such as income and education, exerted a bidirectional influence, which facilitated or hindered vaccine compliance depending on how the social determinant was experienced. Fear of autism was the most cited reason for MMR hesitancy. Vaccine hesitancy to MMR and other childhood vaccines clustered in middle- to high-income areas among mothers with a college-level education or higher who preferred internet/social media narratives over physician-based vaccine information. They had low parental trust, low perceived disease susceptibility, and were skeptical of vaccine safety and benefits. Combating MMR vaccine misinformation and hesitancy requires intersectoral and multifaceted approaches at various socioecological levels to address the social drivers of vaccine behavior. [ABSTRACT FROM AUTHOR]

• Medical school admission requirements do not match national vaccination guidelines. • Observed increase in requests for quantitative proof-of-immunity serology. • Quantitative serology titers should not be used for asymptomatic screening. • Labs are challenged to support admission requirements with inappropriate testing. • Med school admission requirements should be updated to match national guidelines. To assess the guideline concordance of medical school requirements for students' proof-of-immunity in the United States (US) and Canada. National guidelines for healthcare worker proof-of-immunity to measles, mumps, rubella, and varicella were compared to admission requirements for 62 US and 17 Canadian medical schools. All surveyed schools accepted at least one recommended form of proof-of-immunity, however, contrary to national guidelines, 16% of surveyed US schools asked for a serologic titer, and only 73–79% US schools accepted vaccination as the sole proof-of-immunity. The requirement of numerical, non-standardized serologic testing highlights an oversight in medical school admissions documentation. The requirement for quantitative values to demonstrate immunity is not practical from a laboratory standpoint, and is not needed to show individual immunity to these vaccine-preventable diseases. Until a more standardized process is adopted, laboratories will need to provide clear documentation and direction for quantitative titer requests. [ABSTRACT FROM AUTHOR]

The article discusses the decreased vaccine coverage against diseases such as measles and mumps has led to new vulnerabilities in pediatric population health. Topics include global epidemiology of measles; concerns regarding measles and mumps, clinical manifestations and complications of each, diagnostic and treatment options, and, ultimately, prevention of further exposures, and numerous cases and outbreaks have taken root in the U.S.

The article reports that the U.S. Census Bureau projects that by 2050 about half of all dermatologic patients who require treatment will have a skin of color and other skin conditions can present differently in patients with a darker complexion, but primary care physicians and dermatologists. Topics include dermatologic literature describe pathology presentations in people of color; and medical students have reduced accuracy in diagnosing skin conditions or disease on darker skin.

Background: Lockdowns imposed throughout the US to control the COVID-19 pandemic led to a decline in all routine immunizations rates, including the MMR (measles, mumps, rubella) vaccine. It is feared that post-lockdown, these reduced MMR rates will lead to a resurgence of measles.Methods: To measure the potential impact of reduced MMR vaccination rates on measles outbreak, this research examines several counterfactual scenarios in pre-COVID-19 and post-COVID-19 era. An agent-based modeling framework is used to simulate the spread of measles on a synthetic yet realistic social network of Virginia. The change in vulnerability of various communities to measles due to reduced MMR rate is analyzed.Results: Results show that a decrease in vaccination rate [Formula: see text] has a highly non-linear effect on the number of measles cases and this effect grows exponentially beyond a threshold [Formula: see text]. At low vaccination rates, faster isolation of cases and higher compliance to home-isolation are not enough to control the outbreak. The overall impact on urban and rural counties is proportional to their population size but the younger children, African Americans and American Indians are disproportionately infected and hence are more vulnerable to the reduction in the vaccination rate.Conclusions: At low vaccination rates, broader interventions are needed to control the outbreak. Identifying the cause of the decline in vaccination rates (e.g., low income) can help design targeted interventions which can dampen the disproportional impact on more vulnerable populations and reduce disparities in health. Per capita burden of the potential measles resurgence is equivalent in the rural and the urban communities and hence proportionally equitable public health resources should be allocated to rural regions. [ABSTRACT FROM AUTHOR]

Measles is one the best-documented and most-mechanistically-studied non-linear infectious disease dynamical systems. However, systematic investigation into the comparative performance of traditional mechanistic models and machine learning approaches in forecasting the transmission dynamics of this pathogen are still rare. Here, we compare one of the most widely used semi-mechanistic models for measles (TSIR) with a commonly used machine learning approach (LASSO), comparing performance and limits in predicting short to long term outbreak trajectories and seasonality for both regular and less regular measles outbreaks in England and Wales (E&W) and the United States. First, our results indicate that the proposed LASSO model can efficiently use data from multiple major cities and achieve similar short-to-medium term forecasting performance to semi-mechanistic models for E&W epidemics. Second, interestingly, the LASSO model also captures annual to biennial bifurcation of measles epidemics in E&W caused by susceptible response to the late 1940s baby boom. LASSO may also outperform TSIR for predicting less-regular dynamics such as those observed in major cities in US between 1932–45. Although both approaches capture short-term forecasts, accuracy suffers for both methods as we attempt longer-term predictions in highly irregular, post-vaccination outbreaks in E&W. Finally, we illustrate that the LASSO model can both qualitatively and quantitatively reconstruct mechanistic assumptions, notably susceptible dynamics, in the TSIR model. Our results characterize the limits of predictability of infectious disease dynamics for strongly immunizing pathogens with both mechanistic and machine learning models, and identify connections between these two approaches. Author summary: Machine learning techniques in infectious disease modeling have grown in popularity in recent years. However, systematic investigation into the comparative performance of these approaches with traditional mechanistic models are still rare. In this paper, we compare one of the most widely used semi-mechanistic models for measles (TSIR) with a commonly used machine learning approach (LASSO), comparing performance and limits in predicting short to long term outbreaks of measles, one of the best-documented and most-mechanistically-studied non-linear infectious disease dynamical systems. Our results show that in general the LASSO outperform TSIR for predicting less-regular dynamics, and it can achieve similar performance in other scenarios when compared to the TSIR. The LASSO also has the advantages of not requiring explicit demographic data in model training. Finally, we identify connections between these two approaches and show that the LASSO model can both qualitatively and quantitatively reconstruct mechanistic assumptions, notably susceptible dynamics, in the TSIR model. [ABSTRACT FROM AUTHOR]

Objectives: In 2019 the United States experienced the largest outbreak of measles in 27 years, 19 years after the United States declared measles eliminated. The purpose of this paper was to present a population study of a measles outbreak within Orthodox Jewish communities in New York that led to the elimination of religious exemption for school mandated vaccines. Methods: Peer reviewed articles, news media, health department, and government resources were used to investigate environmental factors that led to this outbreak. State, county, and city immunization records were accessed to explore measles compliance rates before and after policy change. Results: Rockland County had low compliance rates compared to the rest of the state, and the elimination of religious exemptions raised compliance rate almost to state level. In all but one affected New York City zip codes, compliance following policy change rose to 97.95%–99.15%. Conclusions: Overall, changes in measles compliance rates reflect policy goals, but localized differences imply a need for more customized interventions for each unique community. Public health planning to promote vaccination should be sensitive to the concerns and perceptions of each community in order for health interventions to have a positive effect. [ABSTRACT FROM AUTHOR]

Measles, an old and highly contagious disease successfully controlled by vaccination, has revived worldwide epidemics without reaching its elimination and eradication goals. In this review, epidemiological data from the United States and Turkey were mainly analyzed. Vaccine rejection or hesitation has been mentioned as one of the reasons for the recurrence of measles. This review includes evaluating the cases followed in our hospital in three time periods when the number of measles cases increased in our country. Demographic data, vaccination status of the patients, complications, and prognosis were also emphasized. [ABSTRACT FROM AUTHOR]

Background Measles elimination (interruption of endemic measles virus transmission) in the United States was declared in 2000; however, the number of cases and outbreaks have increased in recent years. We characterized the epidemiology of measles outbreaks and measles transmission patterns after elimination to identify potential gaps in the US measles control program. Methods We analyzed national measles notification data from 1 January 2001 to 31 December 2019. We defined measles infection clusters as single cases (isolated cases not linked to additional cases), 2-case clusters, or outbreaks with ≥3 linked cases. We calculated the effective reproduction number (R) to assess changes in transmissibility and reviewed molecular epidemiology data. Results During 2001–2019, a total of 3873 measles cases, including 747 international importations, were reported in the United States; 29% of importations were associated with outbreaks. Among 871 clusters, 69% were single cases and 72% had no spread. Larger and longer clusters were reported since 2013, including 7 outbreaks with >50 cases lasting >2 months, 5 of which occurred in known underimmunized, close-knit communities. No measles lineage circulated in a single transmission chain for >12 months. Higher estimates of R were noted in recent years, although R remained below the epidemic threshold of 1. Conclusions Current epidemiology continues to support the interruption of endemic measles virus transmission in the United States. However, larger and longer outbreaks in recent postelimination years and emerging trends of increased transmission in underimmunized communities emphasize the need for targeted approaches to close existing immunity gaps and maintain measles elimination. [ABSTRACT FROM AUTHOR]

Background In 2018-2019, large outbreaks of measles occurred in Israel and in New York City, driven in part by travel of unimmunized children between the 2 communities. Methods A retrospective chart review was conducted for children tested for measles (March 2018-September 2019) at NYU Langone Health in New York, NY, and in Ramla subdistrict, Israel. Vaccination records were reviewed to determine vaccination status for measles, mumps, and rubella (MMR) at the time of measles testing and 1-year post-testing. Results A total of 264 children were tested for measles, and 102 (38.6%) had confirmed measles. Only 20 (19.6%) of measles-positive cases received a full 2-dose course of vitamin A. 82.4% of children with measles were ≥1 year at the time of diagnosis and fully eligible for MMR vaccine. Of the 100 measles-positive cases with available vaccine records, 63 were unvaccinated at testing, and 27 remained unimmunized against MMR 1 year later. At testing, measles-negative children were significantly more likely to have received MMR than measles-positive children (65.4% vs 37%, P  < .01). One year later, 70.4% of measles-negative cases and only 57.1% of measles-positive cases had received MMR vaccine (P  = .18). Conclusions The majority of measles cases occurred in unimmunized children eligible for vaccination, and >25% of children in both measles-positive and -negative groups remained unimmunized for MMR 1-year post-outbreak. Our results suggest the need for novel, longitudinal vaccination strategies and increased awareness of the role of vitamin A. [ABSTRACT FROM AUTHOR]

Measles is a vaccine-preventable, highly contagious virus once considered eradicated in the US. It is still a significant source of morbidity and mortality for children under 5 years of age worldwide. Advanced practice registered nurses are on the frontlines of reducing the spread of disease and educating the community on measles prevention. [ABSTRACT FROM AUTHOR]

On August 29, 2021, the United States government oversaw the emergent establishment of Operation Allies Welcome (OAW), led by the U.S. Department of Homeland Security (DHS) and implemented by the U.S. Department of Defense (DoD) and U.S. Department of State (DoS), to safely resettle U.S. citizens and Afghan nationals from Afghanistan to the United States. Evacuees were temporarily housed at several overseas locations in Europe and Asia* before being transported via military and charter flights through two U.S. international airports, and onward to eight U.S. military bases,† with hotel A used for isolation and quarantine of persons with or exposed to certain infectious diseases.§ On August 30, CDC issued an Epi-X notice encouraging public health officials to maintain vigilance for measles among Afghan evacuees because of an ongoing measles outbreak in Afghanistan (25,988 clinical cases reported nationwide during January-November 2021) (1) and low routine measles vaccination coverage (66% and 43% for the first and second doses, respectively, in 2020) (2). [ABSTRACT FROM AUTHOR]

We present the AdaptSPEC-X method for the joint analysis of a panel of possibly nonstationary time series. The approach is Bayesian and uses a covariate-dependent infinite mixture model to incorporate multiple time series, with mixture components parameterized by a time-varying mean and log spectrum. The mixture components are based on AdaptSPEC, a nonparametric model which adaptively divides the time series into an unknown number of segments and estimates the local log spectra by smoothing splines. AdaptSPEC-X extends AdaptSPEC in three ways. First, through the infinite mixture, it applies to multiple time series linked by covariates. Second, it can handle missing values, a common feature of time series which can cause difficulties for nonparametric spectral methods. Third, it allows for a time-varying mean. Through these extensions, AdaptSPEC-X can estimate time-varying means and spectra at observed and unobserved covariate values, allowing for predictive inference. Estimation is performed by Markov chain Monte Carlo (MCMC) methods, combining data augmentation, reversible jump, and Riemann manifold Hamiltonian Monte Carlo techniques. We evaluate the methodology using simulated data, and describe applications to Australian rainfall data and measles incidence in the United States. Software implementing the method proposed in this article is available in the R package BayesSpec. Supplementary files for this article are available online. [ABSTRACT FROM AUTHOR]

In 2019, there were multiple outbreaks of measles in the United States. In the context of the public awareness of these outbreaks, we performed an intervention with the intent to improve the rate of measles immunization in our pediatric population. Pediatric patients that were lacking adequate measles immunization were identified by electronic medical record (EMR) survey. Charts were reviewed and updated if records were found to be incomplete. Parents of the remaining children were sent a letter, personally signed by the child's primary care provider, encouraging measles immunization. A measles fact sheet, produced by the United States Center for Disease Control, was also included with the letter. There were 44 patients in the study group whose parents received a letter and measles fact sheet. As a result, 5 of these children were brought in for a measles, mumps, and rubella (MMR) immunization. The 44 patients whose parents received a letter included 20 patients whose parents had previously expressed intent to not vaccinate their children as documented in the EMR. None of these children received an MMR immunization. Although small in scope, this project provides a glimpse into the importance of personal provider guidance to parents who are inclined to immunize their children. Unfortunately, it also demonstrated that provider advice did not change the opinions of parents who had already taken a stance against vaccination, even in the context of an urgent public health situation that had garnered widespread coverage in the lay press and social media. [ABSTRACT FROM AUTHOR]

Nationally, immunization delivery has decreased significantly during the coronavirus disease 2019 (COVID-19) pandemic. Internationally, >60 national vaccine programs have been disrupted or suspended. As a result of these immunization declines, the global community is at risk for a resurgence in vaccine-preventable infections including measles, pertussis, and polio—all highly contagious diseases that result in significant morbidity and mortality in children. Measles outbreaks have already occurred in many countries that suspended their vaccination programs. Outbreaks in the United States are likely to occur when social distancing stops and children return to school. Healthcare providers have acted quickly to institute multiple risk mitigation strategies to restore vaccine administration. However, childhood immunization rates remain below pre–COVID-19 levels. Partnerships between healthcare providers, community leaders, and local, state, regional, and national public health departments are needed to reassure families that vaccine delivery during COVID-19 is safe and to identify and catch up those children who are underimmunized. [ABSTRACT FROM AUTHOR]

In 2019, the United States (US) experienced the highest number of measles importations and cases in the postelimination era. More than a quarter of imported cases entered the US through California. Measles surveillance efforts in California resulted in the identification of 26 importations, 6 outbreaks, and 72 cases in 2019. Only genotype B3 and D8 measles strains were detected. Genotype-specific differences were noted in the incidence of vaccine failures, hospitalizations, and severe complications among cases. A targeted whole genome sequencing approach provided higher-resolution discrimination between epidemiologically linked and sporadically introduced strains than conventional N450 sequencing. Our report underscores the importance of ensuring appropriate measles vaccination status, especially prior to international travel to measles-endemic regions, and highlights the value of a strong measles surveillance system in minimizing outbreaks and preserving measles elimination status in the US. [ABSTRACT FROM AUTHOR]

Measles and mumps virus outbreaks have become increasingly common in the United States between 2000 and 2019. While reported cases declined in 2020 and have remained low so far in 2021, reduced vaccination rates provide concern for post-COVID-19 pandemic outbreaks of both infections. [ABSTRACT FROM AUTHOR]

The purpose of this review is to understand the information reported by public health department websites to communities and what trends this data revealed about the 2019 measles outbreak. Methods: Publicly available press releases from health departments reporting measles cases in 2019 were reviewed; the number, age, vaccination status, and mode of transmission of cases were recorded. Results: Of all press releases reviewed, county health departments consisted of the majority of reporting agencies, closely followed by state departments. Of the 1,259 cases we identified, few press releases reported specific information about individual cases. The age was reported in 12.8% of cases, vaccination status in 10.6% and mode of transmission in 17.2% of all cases. Of the information reported, 57.8% of confirmed measles cases were pediatric, followed by 37.3% adult and 5.0% infant; 92.5% of cases were unvaccinated. The primary mode of transmission was through local outbreaks, followed by family members or close contacts, international travel, and domestic travel. New York, Washington, and California were the three highest in the number of measles cases by state. Conclusion: Press releases reported by health department websites provide limited information about measles outbreaks in local areas. Information emphasized in these reports suggests that the unvaccinated and pediatric populations are at high risk for measles. School vaccine exemptions and vaccine refusal are probable causes of the 2019 outbreak and highlight the need to increase vaccination rates. [ABSTRACT FROM AUTHOR]

Background: To understand operational challenges involved with responding to US measles outbreaks in 2017-19 and identify applicable lessons in order to inform preparedness and response operations for future outbreaks, particularly with respect to specific operational barriers and recommendations for outbreak responses among insular communities.Methods: From August 2019 to January 2020, we conducted 11 telephone interviews with 18 participants representing state and local health departments and community health centers that responded to US measles outbreaks in 2017-19, with a focus on outbreaks among insular communities. We conducted qualitative, thematic coding to identify and characterize key operational challenges and lessons identified by the interviewees.Results: We categorized principal insights into 5 topic areas: scale of the response, vaccination operations, exclusion policies, community engagement, and countering anti-vaccine efforts. These topics address resource-intensive aspects of these outbreak responses, including personnel demands; guidance needed to support response operations and reduce transmission, such as excluding exposed or at-risk individuals from public spaces; operational challenges and barriers to vaccination and other response activities; and effectively engaging and educating affected populations, particularly with respect to insular and vulnerable communities.Conclusions: Measles outbreak responses are resource intensive, which can quickly overwhelm existing public health capacities. Early and effective coordination with trusted leaders and organizations in affected communities, including to provide vaccination capacity and facilitate community engagement, can promote efficient response operations. The firsthand experiences of public health and healthcare personnel who responded to measles outbreaks, including among insular communities, provide evidence-based operational lessons that can inform future preparedness and response operations for outbreaks of highly transmissible diseases. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: Between December 31, 2018, and April 26, 2019, 72 confirmed cases of measles were identified in Clark County. Our objective was to estimate the economic burden of the measles outbreak from a societal perspective, including public health response costs as well as direct medical costs and productivity losses of affected individuals. METHODS: To estimate costs related to this outbreak from the societal perspective, 3 types of costs were collected or estimated: public health response (labor, material, and contractor costs used to contain the outbreak), direct medical (third party or patient out-of-pocket treatment costs of infected individuals), and productivity losses (costs of lost productivity due to illness, home isolation, quarantine, or informal caregiving). RESULTS: The overall societal cost of the 2019 Clark County measles outbreak was ~$3.4 million ($47 479 per case or $814 per contact). The majority of the costs (~$2.3 million) were incurred by the public health response to the outbreak, followed by productivity losses (~$1.0 million) and direct medical costs (~$76 000). CONCLUSIONS: Recent increases in incident measles cases in the United States and across the globe underscore the need to more fully understand the societal cost of measles cases and outbreaks and economic consequences of undervaccination. Our estimates can provide valuable inputs for policy makers and public health stakeholders as they consider budget determinations and the substantial value associated with increasing vaccine coverage and outbreak preparedness as well as the protection of society against vaccine-preventable diseases, such as measles, which are readily preventable with high vaccination coverage. [ABSTRACT FROM AUTHOR]

A fundamental challenge complicates news decisions about covering vaccine side effects: although serious vaccine side effects are rare, less severe ones do occur occasionally. The study was designed to test whether a side effect message could induce vaccine hesitancy and whether that could be countered by pro-vaccine messages about vaccine safety. A large (N = 2,345), nationally representative experiment was conducted by randomly exposing participants to one of six videos about the measles, mumps, and rubella (MMR) vaccine edited from news programs produced during the 2019 measles outbreak in the United States. The design was a 2x3 factorial crossing the presence or absence of a hesitancy-inducing narrative message with a pro-vaccine science-supporting message (i.e., no message, science-supporting expert message, or pro-vaccine narrative message), leading to a total of six conditions. A general linear model was used to assess the effects of these videos on respondents' (1) vaccine risk perceptions, (2) policy views on vaccination, (3) willingness to encourage others to vaccinate their children, and (4) intention to send a pro-vaccine letter to their state representative. Findings indicated that the science-supporting expert message about vaccine safety led to higher pro-vaccine evaluations relative to other conditions [e.g., b = -0.17, p <.001, a reduction in vaccine risk perceptions of 0.17 as compared to the control]. There was also suggestive evidence that the hesitancy-inducing narrative may limit the effectiveness of a science-supporting expert message, although this finding was not consistent across different outcomes. When shown alone the hesitancy-inducing narrative did not shift views and intentions, but more research is needed to ascertain whether exposure to such messages can undercut the pro-vaccine influence of science-supporting (expert) ones. All in all, however, it is clear that science-supporting messages are effective and therefore worthwhile in combating vaccine misinformation. [ABSTRACT FROM AUTHOR]

• We propose an epidemic model of imperfect vaccination with a latent period a general nonmonotone incidence rate function. • We study the threshold dynamics with respect to the effective reproduction number. • We discuss the critical vaccination coverage rate that is required to eliminate the disease. • We apply the model to data on measles disease transmission and provide sensitivity analysis. • The latent period shows a noticeable effect on system dynamics but not on the effective reproduction number. In this paper, we investigate the effects of the latent period on the dynamics of infectious disease with an imperfect vaccine. We assume a general incidence rate function with a non-monotonicity property to interpret the psychological effect in the susceptible population when the number of infectious individuals increases. After we propose the model, we provide the well-posedness property by verifying the non-negativity and boundedness of the models solutions. Then, we calculate the effective reproduction number R E. The threshold dynamics of the system is obtained with respect to R E. We discuss the global stability of the disease-free equilibrium when R E < 1 and explore the system persistence when R E > 1. Moreover, we prove the coexistence of an endemic equilibrium when the system persists. Then, we discuss the critical vaccination coverage rate that is required to eliminate the disease. Numerical simulations are provided to: (i) implement a case study regarding the measles disease transmission in the United States from 1963 to 2016; (ii) study the local and global sensitivity of R E with respect to the model parameters; (iii) discuss the stability of endemic equilibrium; and (iv) explore the sensitivity of the proposed model solutions with respect to the main parameters. [ABSTRACT FROM AUTHOR]

The measles outbreak that began in December 2014 at the California Disneyland theme park in the United States (U.S.) received a high amount of media attention. Media attention can influence health-related behaviors. We investigated the effect of the Disneyland outbreak on measles-containing vaccine (MCV) uptake among U.S. children. We used 2012–2017 National Immunization Survey-Child (NIS-Child) data to examine MCV uptake among U.S. children by 19 months of age. We classified MCV coverage among birth cohorts as exposed based on age at the time of the outbreak. A difference-in-differences design with adjustment for categorical birth cohort was implemented in base models to estimate the exposure effect on the outcomes, ≥1-dose MCV coverage or age at first MCV dose, with pneumococcal conjugate vaccination as a control. Primary analyses included this model adjusted for geographic region, maternal education, race/ethnicity, household income, and insurance status, and an exposure-interaction term with maternal education. All analyses included sampling weights. The study population represented 34,471,357 children. In base models, the Disneyland outbreak was associated with a 1.0% (95% CI: 0.2%, 1.8%) increase in ≥1-dose MCV coverage and a 6.6 (95% CI: 4.8, 8.5)-day decrease in MCV administration age. In primary analyses, the outbreak was associated with a 3.9% (95% CI: 3.1%, 4.8%) increase in ≥1-dose MCV coverage among children of college-educated mothers, and a 3.2% (95% CI: 0.6%, 5.9%) decrease among children of mothers earning less than a high school degree. Decreases in MCV administration age ranging from 5.9 (95% CI: 3.3, 8.5) to 9.1 (95% CI: 6.8, 11.4) days were observed across maternal education categories. The Disneyland outbreak was associated with differential effects on MCV coverage by maternal education and decreases in MCV administration age among U.S. children. These findings may provide useful insights to inform methods to address pediatric MCV undervaccination. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss the possible adverse effects of vaccine exemptions and the risk of sustained disease outbreaks to the pediatric populations in the U.S. Also cited are how the low coronavirus disease 2019 (COVID-19) vaccination among young people accelerated the spread of the Delta variant, and the main reasons behind poor pediatric vaccination coverage like outright vaccine refusal or hesitancy.

The United States experienced historically high numbers of measles cases in 2019, despite achieving national measles vaccination rates above the World Health Organization recommendation of 95% coverage with two doses. Since the COVID-19 pandemic began, resulting in suspension of many clinical preventive services, pediatric vaccination rates in the United States have fallen precipitously, dramatically increasing risk of measles resurgence. Previous research has shown that measles outbreaks in high-coverage contexts are driven by spatial clustering of nonvaccination, which decreases local immunity below the herd immunity threshold. However, little is known about how to best conduct surveillance and target interventions to detect and address these high-risk areas, and most vaccination data are reported at the statelevel-- a resolution too coarse to detect community-level clustering of nonvaccination characteristic of recent outbreaks. In this paper, we perform a series of computational experiments to assess the impact of clustered nonvaccination on outbreak potential and magnitude of bias in predicting disease risk posed by measuring vaccination rates at coarse spatial scales. We find that, when nonvaccination is locally clustered, reporting aggregate data at the state- or county-level can result in substantial underestimates of outbreak risk. The COVID-19 pandemic has shone a bright light on the weaknesses in US infectious disease surveillance and a broader gap in our understanding of how to best use detailed spatial data to interrupt and control infectious disease transmission. Our research clearly outlines that finer-scale vaccination data should be collected to prevent a return to endemic measles transmission in the United States. [ABSTRACT FROM AUTHOR]

Despite the elimination of measles in the United States (US) in the year 2000, cases continue to occur, with measles outbreaks having occurred in various jurisdictions in the US in 2018 and 2019. Understanding the cost associated with measles outbreaks can inform cost-of-illness and cost-effectiveness studies of measles and measles prevention. We performed a literature review and identified 10 published studies from 2001 through 2018 that presented cost estimates from 11 measles outbreaks. The median total cost per measles outbreak was $152 308 (range, $9862–$1 063 936); the median cost per case was $32 805 (range, $7396–$76 154) and the median cost per contact was $223 (range, $81–$746). There were limited data on direct and indirect costs associated with measles. These findings highlight how costly measles outbreaks can be, the value of this information for public health department budgeting, and the importance of more broadly documenting the cost of measles outbreaks. [ABSTRACT FROM AUTHOR]

Although the rates of childhood vaccination are still high in the United States, there has been an increase in vocal vaccine deniers. Regardless that the safety and efficacy of vaccines has been well established through evidence-based medicine, these individuals are relentless in their beliefs and are dismissive of scientific research. Subsequently, there have been several outbreaks of measles, a serious vaccine preventable disease. How should we as medical providers address this trend? This article provides an expert opinion by Dr. Paul A. Offit a renowned and highly respected pediatric infectious disease physician, to consider non-vaccination of healthy children as a form of neglect. [ABSTRACT FROM AUTHOR]

The article address whether overarching health concerns overwhelm perceived burdens on parents' First Amendment freedoms so as to make religious exemptions a luxury, as opposed to a constitutional mandate. It mentions decision of the U.S. Supreme Court in the case Wisconsin v. Yoder on measles outbreaks in schools tend to make it very difficult. It also mentions repealing religious exemptions to mandatory vaccination laws and challenge to a mandatory immunization.

Despite the established safety and efficacy of the measles-mumps-rubella vaccine after almost 50 years of widespread use, the United States is encountering higher levels of measles and mumps disease than has occurred for years. Return of disease threatens the health of those who remain unimmunized by choice as well as those who are immunized appropriately but experience loss of vaccine-induced immunity. The solution to continued threats of illness caused by these untreatable but readily preventable diseases is compliance with recommendations for administration of the measlesmumps- rubella vaccine. Here we examine trends in the epidemiology of measles, mumps, and rubella in recent years and consider the consequences of loss of protective immunity within our country. [ABSTRACT FROM AUTHOR]

Background: In health and medicine, people heavily use the Internet to search for information about symptoms, diseases, and treatments. As such, the Internet information can simulate expert medical doctors, pharmacists, and other health care providers. Aim: This article aims to evaluate a dataset of search terms to determine whether search queries and terms can be used to reliably predict skin disease breakouts. Furthermore, the authors propose and evaluate a model to decide when to declare a particular month as Epidemic at the US national level. Methods: A Model was designed to distinguish a breakout in skin diseases based on the number of monthly discovered cases. To apply this model, the authors correlated Google Trends of popular search terms with monthly reported Rubella and Measles cases from Centers for Disease Control and Prevention (CDC). Regressions and decision trees were used to determine the impact of different terms to trigger the occurrence of epidemic classes. Results: Results showed that the volume of search keywords for Rubella and Measles rises when the volume of those reported diseases rises. Results also implied that the overall process was successful and should be repeated with other diseases. Such process can trigger different actions or activities to be taken when a certain month is declared as "Epidemic." Furthermore, this research has shown great interest for vaccination against Measles and Rubella. Conclusions: The findings suggest that the search queries and keyword trends can be truly reliable to be used for the prediction of disease outbreaks and some other related knowledge extraction applications. Also search-term surveillance can provide an additional tool for infectious disease surveillance. Future research needs to re-apply the model used in this article, and researchers need to question whether characterizing the epidemiology of Coronavirus Disease 2019 (COVID-19) pandemic waves in United States can be done through search queries and keyword trends. [ABSTRACT FROM AUTHOR]

Background: Measles is an extremely contagious, vaccine-preventable infection that was officially declared eradicated in the US in 2000. However, measles outbreaks are increasingly occurring in the US. Measles cases have considerable morbidity requiring hospitalization, yet little is known about hospitalization and complications from measles in recent years. Objectives: To analyze the frequency, predictors, costs and other outcomes of hospitalization for measles in the US. Methods: The 2002–2016 Nationwide Inpatient Sample, containing a 20% sample of US hospitalizations (n = 96,568,625), was analyzed. Measles and comorbidities were defined by International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) or ICD-10-CM codes. Multivariable survey logistic regression and linear regression models controlling for sociodemographic demographic factors were constructed to understand associations with organ-specific complications, and cost of care and length of stay, respectively. Results: Overall, 1,018 measles hospitalizations occurred in 2002–2016, and hospitalizations increased over time. In multivariable logistic regression models, measles was associated with higher odds of gastrointestinal, hematologic, infectious, neurologic, ophthalmologic, pulmonary, and renal complications, with the strongest association observed with encephalitis (39.84 [16.51–96.12], P<0.0001). Increased length of stay (LOS) and similar cost of care (mean [95% CI]; 4.8 [4.4–5.4]; $7,438 [$6,446-$8,582]) were observed versus (vs.) all other admissions (4.5 [4.4–4.5]; P<0.01; $7,854 [$7,774-$7,935], P>0.05). There were 34 deaths in hospitalized measles patients; inpatient mortality was numerically higher in those with vs. without measles (proportion ± SEM: 3.3±1.2% vs. 2.3±0.01%, P = 0.333). Limitations: Lack of outpatient or prescription data. Conclusions: Measles continues to pose a substantial and preventable health care burden, with serious complications, hospitalization and inpatient mortality. Further studies are needed to improve the prevention and management of measles. [ABSTRACT FROM AUTHOR]

Background: It is vital for frontline emergency physicians to immediately recognize the signs and symptoms of measles to initiate appropriate therapy and prevent spread to the health care team and other patients.Objective: This review serves as a clinically practical updated reference for when the differential diagnosis includes measles.Discussion: Measles is a highly contagious illness that classically presents with a rash, fever, cough, coryza, and conjunctivitis. Cases in the United States since 2000 have been attributed mainly to travelers who are infected abroad and then spread the illness to small, susceptible populations within the United States. Complications from measles are relatively common and can be associated with significant morbidity and mortality. Clinical suspicion should be confirmed with laboratory testing, which is most commonly a serum immunoglobulin M. The management of measles is mainly supportive. Patients that require more aggressive management include those who are pregnant, immunocompromised, or unvaccinated. Treatment may consist of the measles vaccine, intravenous immunoglobulin, vitamin A, and even ribavirin. Additionally, special precautions are required by hospital workers to help prevent the spread of the virus, which include N-95 masks and patient isolation in an airborne infection isolation room.Conclusion: Emergency physicians must be readily able to identify, contain patients with suspected measles, and determine who will need further medical management for this potentially life-threatening illness. As this public health crisis evolves, novel ways of screening for and reporting cases of measles is needed. [ABSTRACT FROM AUTHOR]

The article offers news briefs related to nursing industry in the U.S. Topics include people and advocacy organizations sent a letter to Facebook chief executive officer Mark Zuckerberg demanding that Facebook and its subsidiary, Instagram, cease accepting advertisements with false or misleading warnings about Truvada; and . Home deaths have surpassed hospital deaths in the U.S. for the first time since the early 20th century, as reported in the New England Journal of Medicine.

Measles has re-emerged in the US for a variety of reasons, including misinformation spread by antivaccination advocates and imported cases from countries where infected children may be too young for immunization. Prompt diagnosis and isolation can help reduce measles transmission. [ABSTRACT FROM AUTHOR]

Measles has reemerged in the US for a variety of reasons, including misinformation spread by antivaccination advocates and imported cases from countries where infected children may be too young for immunization. Prompt diagnosis and isolation can help reduce measles transmission. [ABSTRACT FROM AUTHOR]

Until recently, measles exposures were relatively rare and so, consequently, were an afterthought for cancer patients and/or blood and marrow transplant recipients and their providers. Declines in measles herd immunity have reached critical levels in many communities throughout the United States due to increasing vaccine hesitancy, so that community-based outbreaks have occurred. The reemergence of measles as a clinical disease has raised serious concerns among immunocompromised patients and those who work within the cancer and hematopoietic cell transplantation (HCT) community. Since live attenuated vaccines, such as measles, mumps, and rubella (MMR), are contraindicated in immunocompromised patients, and with no approved antiviral therapies for measles, community exposures in these patients can lead to life-threatening infection. The lack of data regarding measles prevention in this population poses a number of clinical dilemmas. Herein specialists in Infectious Diseases and HCT/cellular therapy endorsed by the American Society of Transplant and Cellular Therapy address frequently asked questions about measles in these high-risk cancer patients and HCT recipients and provide expert opinions based on the limited available data. [ABSTRACT FROM AUTHOR]

During January 1-October 1, 2019, a total of 1,249 measles cases and 22 measles outbreaks were reported in the United States. This represents the most U.S. cases reported in a single year since 1992 (1), and the second highest number of reported outbreaks annually since measles was declared eliminated* in the United States in 2000 (2). Measles is an acute febrile rash illness with an attack rate of approximately 90% in susceptible household contacts (3). Domestic outbreaks can occur when travelers contract measles outside the United States and subsequently transmit infection to unvaccinated persons they expose in the United States. Among the 1,249 measles cases reported in 2019, 1,163 (93%) were associated with the 22 outbreaks, 1,107 (89%) were in patients who were unvaccinated or had an unknown vaccination status, and 119 (10%) measles patients were hospitalized. Closely related outbreaks in New York City (NYC) and New York State (NYS; excluding NYC), with ongoing transmission for nearly 1 year in large and close-knit Orthodox Jewish communities, accounted for 934 (75%) cases during 2019 and threatened the elimination status of measles in the United States. Robust responses in NYC and NYS were effective in controlling transmission before the 1-year mark; however, continued vigilance for additional cases within these communities is essential to determine whether elimination has been sustained. Collaboration between public health authorities and undervaccinated communities is important for preventing outbreaks and limiting transmission. The combination of maintenance of high national vaccination coverage with measles, mumps, and rubella vaccine (MMR) and rapid implementation of measles control measures remains the cornerstone for preventing widespread measles transmission (4). [ABSTRACT FROM AUTHOR]

The measles outbreaks have been occurring in multiple areas in the United States. The number of confirmed measles cases for the first half of 2019 has already recorded the highest in the last twenty years since the government had declared its elimination in 2000. Measles is a highly contagious disease that is responsible for millions of deaths in the past; however, it is almost completely preventable with vaccination nowadays. Maintaining herd immunity in the population is crucial. The declining rates of vaccination in certain communities or groups of people have led to a sharp spike of measles cases in a short period of time. Methods: Epidemiological data for recent measles outbreaks were collected from CDC and corresponding local health departments to examine the facts about recent outbreaks and their reasons. Results: Data have shown that the vast majority of measles cases occurred in younger children whose parents chose not to vaccinate them. The local health authorities have been putting efforts to stop the chains of infections by ordering mandatory vaccination and eliminating non-medical exemptions based on religious or personal beliefs. Conclusion: The skepticism around autism spectrum disorder and the MMR vaccine still persists among those who are reluctant to get vaccinated despite numerous scientific research studies proving the safety of vaccines. The effects of current interventions are yet to be visualized but it would require concurrent education and health policy adaptation to sway the social norms and make changes in people who are not adhering to vaccination requirements. [ABSTRACT FROM AUTHOR]

We show that the first nationwide mass vaccination campaign against measles increased educational attainment in the United States. Our empirical strategy exploits variation in exposure to the childhood disease across states right before the Measles Eradication Campaign of 1967–68, which reduced reported measles incidence by 90 percent within two years. Our results suggest that mass vaccination against measles increased the years of education on average by about 0.1 years in the affected cohorts. We also find tentative evidence that the college graduation rate of men increased. [ABSTRACT FROM AUTHOR]

Social media posts regarding measles vaccination were classified as pro-vaccination, expressing vaccine hesitancy, uncertain, or irrelevant. Spearman correlations with Centers for Disease Control and Prevention-reported measles cases and differenced smoothed cumulative case counts over this period were reported (using time series bootstrap confidence intervals). A total of 58,078 Facebook posts and 82,993 tweets were identified from 4 January 2009 to 27 August 2016. Pro-vaccination posts were correlated with the US weekly reported cases (Facebook: Spearman correlation 0.22 (95% confidence interval: 0.09 to 0.34), Twitter: 0.21 (95% confidence interval: 0.06 to 0.34)). Vaccine-hesitant posts, however, were uncorrelated with measles cases in the United States (Facebook: 0.01 (95% confidence interval: -0.13 to 0.14), Twitter: 0.0011 (95% confidence interval: -0.12 to 0.12)). These findings may result from more consistent social media engagement by individuals expressing vaccine hesitancy, contrasted with media- or event-driven episodic interest on the part of individuals favoring current policy. [ABSTRACT FROM AUTHOR]