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Background Industrialization and demographic transition generate nonstationary dynamics in human populations that can affect the transmission and persistence of infectious diseases. Decades of increasing vaccination and development have led to dramatic declines in the global burden of measles, but the virus remains persistent in much of the world. Here we show that a combination of demographic transition, as a result of declining birth rates, and reduced measles prevalence, due to improved vaccination, has shifted the age distribution of susceptibility to measles throughout China. Methods and findings We fit a novel time-varying catalytic model to three decades of age-specific measles case reporting in six provinces in China to quantify the change in the age-specific force of infection for measles virus over time. We further quantified the impact of supplemental vaccination campaigns on the reduction of susceptible individuals. The force of infection of measles has declined dramatically (90%-97% reduction in transmission rate) in three industrialized eastern provinces during the last decade, driving a concomitant increase in both the relative proportion and absolute number of adult cases, while three central and western provinces exhibited dynamics consistent with endemic persistence (24%-73% reduction in transmission rate). The reduction in susceptible individuals due to supplemental vaccination campaigns is frequently below the nominal campaign coverage, likely because campaigns necessarily vaccinate those who may already be immune. The impact of these campaigns has significantly improved over time: campaigns prior to 2005 were estimated to have achieved less than 50% reductions in the proportion susceptible in the target age classes, but campaigns from 2005 onwards reduced the susceptible proportion by 32%-87%. A limitation of this study is that it relies on case surveillance, and thus inference may be biased by age-specific variation in measles reporting. Conclusions The age distribution of measles cases changes in response to both demographic and vaccination processes. Combining both processes in a novel catalytic model, we illustrate that age-specific incidence patterns reveal regional differences in the progress to measles elimination and the impact of vaccination controls in China. The shift in the age distribution of measles susceptibility in response to demographic and vaccination processes emphasizes the importance of progressive control strategies and measures to evaluate program success that anticipate and react to this transition in observed incidence., Author(s): Sheng Li 1, Chao Ma 2, Lixin Hao 2, Qiru Su 2, Zhijie An 2, Fubao Ma 3, Shuyun Xie 4, Aiqiang Xu 5, Yanyang Zhang 6, Zhengrong Ding [...]

Purpose – The purpose of this paper is to assess the behavioural and psychological effects on people with intellectual disabilities of transferring to an environment influenced by patient choice and low secure standards. Design/methodology/approach – Patients and staff transferring from a non-optimal environment to one driven by low secure standards compared the homeliness, ward climate and satisfaction with the two wards. Comparisons were made between the occurrences of risk behaviours on the two wards. Findings – The new environment was rated by staff as more homely while patients’ increased satisfaction with the new ward was reflected in social climate ratings of patient cohesion and experienced safety. The latter findings were reinforced by an objective reduction in risk behaviours in the new environment. Practical implications – Treatment interventions need to optimise research findings that attest to the influence of the environment on the behaviour of patients with intellectual disabilities.Originality/value – Findings highlight need to increase the focus on aspects of the built environment in planning the treatment of women in secure care. [ABSTRACT FROM AUTHOR]

A letter to the editor regarding adverse events following immunization (AEFI) caused by a measles vaccine is presented.

Objective: To characterize patients with suspected measles, determine the magnitude of the outbreak in selected areas, and perform laboratory testing on patients with suspected measles to confirm the etiology of the outbreak., Study Design: Cross-sectional survey., Place and Duration of Study: Islamabad and Rawalpindi in June 2006., Methodology: Survey and specimen collection from households was carried out in areas affected by rash and fever during the outbreak. Teams asked if household members had rash and fever and administered a detailed questionnaire of clinical signs and symptoms for measles for each person who reported a rash and fever episode. A sample of cases with fever, rash, and either cough, conjunctivitis, or coryza was laboratory tested for measles and rubella., Results: Of 2,225 households visited, 284 individuals met the rash and fever case definition. Laboratory testing of eleven blood specimens revealed that the rash and fever outbreak was caused by rubella in 6 and measles in 2 with three equivocal results., Conclusion: Laboratory confirmation of suspected measles cases is essential during measles elimination activities in Pakistan and other countries with endemic rubella.