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Introduction: Measles is an extremely contagious viral disease that can be prevented through vaccination. It is caused by the measles virus and presents with symptoms such as high fever, cough, runny nose, conjunctivitis, and a distinctive rash. Complications may include pneumonia, diarrhoea, and neurological issues. The disease spreads through respiratory droplets and continues to pose a significant public health challenge, especially in Africa, despite vaccination efforts., Objective: This systematic review and meta-analysis aim to estimate the pooled vaccine effectiveness of measles vaccines among African children, providing insights into immunization program success and informing policy decisions on vaccine distribution and resource allocation., Methods: Following PRISMA guidelines, search was conducted in databases including PubMed/Medline, Science Direct, HINARI, Cochrane/Wiley library, Europe PMC, and grey literatures like Google Scholar up to March 2024. Cross-sectional studies assessed measles vaccine effectiveness in African children aged nine months and above were included. Data was extracted using JBI extraction tool and entered into microsoft excel and analysed via STATA version 20.1 using random effect model., Results: From 5295 identified articles, 18 met the inclusion criteria, encompassing 26,470 children from 13 African countries. The pooled measles vaccine effectiveness was 68.58%, with significant heterogeneity (I2 = 99.66%, p < 0.001). Subgroup analysis showed variability in vaccine effectiveness by study period, with higher effectiveness in studies conducted after the Global Vaccine Action Plan (GVAP) in 2012., Conclusion: Measles vaccine effectiveness varies in African regions, ranging from 98.4% in Nigeria to 36.5% in Mozambique, with an overall effectiveness of 68.58% and high heterogeneity among studies. Optimizing vaccine distribution, increasing coverage, and prompt administration are important for enhancing effectiveness. Continued support for GVAP strategies and further research is needed to understand factors affecting vaccine performance and improve immunization efforts in Africa., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Abstract: The Sunshine Coast Public Health Unit (SCPHU) identified a measles case in a childcare educator (CE) with secondary vaccine failure (SVF). The CE had been exposed to a confirmed measles case in a hospital emergency department and later developed symptoms including fever, cough, malaise, and a rash. Diagnostic tests confirmed measles virus infection. Sunshine Coast Public Health Unit (SCPHU) implemented control measures including contact tracing, vaccination, post-exposure prophylaxis, and quarantine for susceptible contacts. Out of 372 identified contacts, 72 were identified as susceptible, all of whom were infants and children. Despite the CE having close contact to all susceptible infants and children, no onward transmission occurred. This suggests that SVF cases pose a lower risk of spreading measles compared to immunologically naïve individuals. This report highlights the importance of prioritising immunologically naïve cases in outbreak responses., (© Commonwealth of Australia CC BY-NC-ND.)

The persistence of measles in many countries demonstrates large immunity gaps, resulting from incomplete or ineffective immunization with measles-containing vaccines (MCVs). MCV impact is determined, in part, by vaccination age. Infants who receive dose 1 (MCV1) at older ages have a reduced risk of vaccine failure, but also an increased risk of contracting infection before vaccination. Here, we designed a new method-based on a mathematical transmission model incorporating realistic vaccination delays and age variations in MCV1 effectiveness-to capture the MCV1 age risk trade-off and estimate the optimal age for recommending MCV1. We applied this method to a range of synthetic populations representing lower- and higher-income populations. We predict a large heterogeneity in the optimal MCV1 ages (range: 6-20 months), contrasting the homogeneity of observed recommendations worldwide. Furthermore, we show that the optimal age depends on the local epidemiology of measles, with a lower optimal age predicted in populations having lower vaccination coverage or suffering higher transmission. Overall, our results suggest the scope for public health authorities to tailor the recommended schedule for better measles control., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Despite the availability of a safe and effective measles vaccine in Ethiopia, the country has experienced recurrent and significant measles outbreaks, with a nearly fivefold increase in confirmed cases from 2021 to 2023. The WHO has identified being unvaccinated against measles as a major factor driving this resurgence of cases and deaths. Consequently, this study aimed to apply robust machine learning algorithms to predict the key factors contributing to measles vaccination dropout., Methods: This study utilised data from the 2016 Ethiopian Demographic and Health Survey to evaluate measles vaccination dropout. Eight supervised machine learning algorithms were implemented: eXtreme Gradient Boosting (XGBoost), Random Forest, Gradient Boosting, Support Vector Machine, Decision Tree, Naïve Bayes, K-Nearest Neighbours and Logistic Regression. Data preprocessing and model development were performed using R language V.4.2.1. The predictive models were evaluated using accuracy, precision, recall, F1-score and area under the curve (AUC). Unlike previous studies, this research utilised Shapley values to interpret individual predictions made by the top-performing machine learning model., Results: The XGBoost algorithm surpassed all classifiers in predicting measles vaccination dropout (Accuracy and AUC values of 73.9% and 0.813, respectively). The Shapley Beeswarm plot displayed how each feature influenced the best model's predictions. The model predicted that the younger mother's age, religion-Jehovah/Adventist, husband with no and mother with primary education, unemployment of the mother, residence in the Oromia and Somali regions, large family size and older paternal age have a strong positive impact on the measles vaccination dropout., Conclusion: The measles dropout rate in the country exceeded the recommended threshold of <10%. To tackle this issue, targeted interventions are crucial. Public awareness campaigns, regular health education and partnerships with religious institutions and health extension workers should be implemented, particularly in the identified underprivileged regions. These measures can help reduce measles vaccination dropout rates and enhance overall coverage., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Measles vaccination effectively prevents measles, a highly contagious disease that can cause severe complications and death and requires high population immunity to interrupt transmission. This report describes measles elimination progress during 2000-2023. During 2000-2023, an estimated 60.3 million measles deaths were averted by vaccination. However, despite commitment from all six World Health Organization regions to eliminate measles, no region has successfully achieved and maintained measles elimination as of the end of 2023. During the COVID-19 pandemic, estimated global coverage with the first dose of measles-containing vaccine (MCV1) declined to 81%, the lowest level since 2008. MCV1 coverage improved to 83% in 2022 but was unchanged in 2023. From 2022 to 2023, estimated measles cases increased 20% worldwide, from 8,645,000 to 10,341,000; the number of countries experiencing large or disruptive outbreaks increased from 36 to 57. Estimated measles deaths decreased 8%, from 116,800 in 2022 to 107,500 in 2023, primarily because an increased number of cases occurred in countries with lower risk for death. The stagnation in MCV1 coverage means millions of children remain unprotected, leading to increases in cases and outbreaks. Coverage with measles-containing vaccine (MCV) is lower, and measles incidence is higher, in low-income countries and countries experiencing fragile, conflict-affected, and vulnerable settings, which exacerbate inequities. Urgent and targeted efforts are needed to ensure that all children receive 2 MCV doses and that surveillance is strengthened to hasten progress toward measles elimination., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Matt Ferrari reports institutional support from the World Health Organization, Gavi, the Vaccine Alliance, and the Bill and Melinda Gates Foundation; grants or contracts from Gavi, the Vaccine Alliance, the Bill and Melinda Gates Foundation, and the National Science Foundation; and travel support from the World Health Organization, the Bill and Melinda Gates Foundation, and Imperial College. No other potential conflicts of interest were disclosed.

On April 24, 2023, the American Samoa Department of Health (ASDoH) declared a public health emergency amid concern about a possible measles outbreak given low 2-dose vaccination coverage at the time. ASDoH had received two positive measles immunoglobulin (Ig) M test results after Flag Day festivities 1 week earlier from vaccinated children. ASDoH performed active case finding, took actions to mitigate transmission, and requested technical assistance from CDC. ASDoH implemented a vaccination campaign to improve suboptimal coverage. Confirmatory molecular testing of specimens from these initial persons under investigation (PUIs) was not possible, but subsequent testing of specimens from additional PUIs by Hawaii State Laboratories Division and CDC ruled out measles. In settings with low measles prevalence, measles antibody testing results have low positive predictive value and can lead to difficulties with interpreting results. Testing for additional pathogens revealed a variety of viruses known to cause common childhood viral exanthems. Both molecular and serologic testing should be performed for all suspected measles cases. To decrease the probability of false-positive IgM results, testing should be reserved for cases that meet the Council of State and Territorial Epidemiologists measles case definition, especially those in persons with no evidence of immunity and with a history of recent international travel. In addition, maintaining high measles vaccination coverage can prevent future outbreaks., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Annette Fa’alevao Ilimaleota reports travel support from the Pacific Island Health Officers Association and the World Health Organization and an uncompensated leadership role in the U.S.-Affiliated Pacific Islands Serology Technicians Program Collaboration and Service Integration as the Coordinator for American Samoa. No other potential conflicts of interest were disclosed.

Background: The global initiative to eliminate measles, spearheaded by the World Health Organization, has yet to achieve its intended goals. In Turkey, despite robust vaccination strategies, recent increases in measles cases have been attributed to vaccine hesitancy and irregular migration. This study evaluates measles serology within a pediatric population to determine the impact of vaccination regimens on immunity., Methods: A retrospective study at Ankara Bilkent City Hospital analyzed serum measles IgG levels in children aged 1-18 years from January 2020 to August 2023. Exclusions were applied for individuals with positive IgM results, incomplete vaccinations, and immunocompromised conditions. Patients were categorized based on their M-M-R ® II vaccine status into those having received either one or two doses. Seropositivity was assessed using the ELISA method., Results: Of the 686 children, 30.2% received a single dose, and 69.8% received two doses of the MMR vaccine. Overall, 70.7% exhibited positive IgG levels. No significant differences were found in IgG levels between those who received one dose and those who received two doses. However, a decline in IgG levels was observed with age, particularly notable in adolescents aged 14-18 years., Conclusion: The study reveals seropositivity rates lower than expected, highlighting challenges in achieving WHO targets. This suggests a potential need for booster doses during adolescence to maintain protective antibody levels. The findings emphasize the importance of continued surveillance and research to adapt vaccination strategies effectively and prevent measles outbreaks, particularly considering the decline in antibody levels and diverse vaccination histories across populations., Competing Interests: Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical standards of the institutional and national research committees, and with the 1975 Helsinki Declaration and its later amendments. Ethical approval was granted by the Ethics Committee of Ankara Bilkent City Hospital. Where applicable, general consent for the use of medical records in research was obtained as part of the admission process. Consent for publication No interventions were performed on any patients for the purposes of this study; only existing medical records were utilized. Data was anonymized and confidentiality was maintained in compliance with ethical standards. The information used was in accordance with the general consent provided by patients at the time of their admission to the hospital. Competing interests The authors declare no competing interests. Clinical trial registration This study does not involve any clinical trials. Therefore, no clinical trial registration is required., (© 2024. The Author(s).)

Background: Measles, a highly contagious and potentially fatal disease, remains a significant public health concern, particularly in low- and middle-income countries. Vaccination is the most effective way to prevent measles and achieving high immunization coverage is crucial for protecting children and communities. This study investigated the trends and inequalities in measles immunization coverage among two-year-olds in Sierra Leone between 2008 and 2019., Methods: The study utilized data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. The World Health Organisation Health Equity Assessment Toolkit was used to calculate various inequality measures, including Difference (D), Ratio (R), Population Attributable Risk (PAR), and Population Attributable Fraction (PAF). An inequality assessment was conducted for six stratifiers: age, economic status, level of education, place of residence, sex of the child, and sub-national province., Results: In Sierra Leone, measles immunization coverage increased between 2008 and 2013 and decreased slightly in 2019. In 2008, 66.2% of two-year-olds were immunized, which increased to 86.2% in 2013 and then fell slightly to 82.2% in 2019. There was a decrease in inequality for age from 4.2 percentage points in 2008 to 3.0 percentage points in 2019 (D = 4.2 in 2008 and 3.0 in 2019). Economic-related inequality decreased from 8.1 percentage points in 2008 to 7.5 percentage points in 2019 (D = 8.1 in 2008 and 7.5 in 2019). Inequality in education decreased from 10.3 percentage points in 2008 to 7.4 percentage points in 2019 based on results from the inequality measure D. For place of residence, inequality decreased from 6.0 percentage points in 2008 to 4.0 percentage points in 2019. For the child's sex, the inequality increased from 1.9 percentage points in 2008 to 4.5 percentage points in 2019. The PAF revealed that the setting average could have been 1.4% higher in 2008 and 2.7% higher in 2019 without the child's sex inequality. Provincial inequality decreased from 19.4 percentage points in 2008 to 16.9 percentage points in 2019 (D = 19.4 in 2008 and 16.9 in 2019)., Conclusion: The observed fluctuations in national measles immunization coverage for children under two underscore the need for sustained efforts in vaccination programs. While improvements in access based on age, socioeconomic status, education level, and place of residence suggest progress in reducing inequalities, the persistent provincial disparities, with a significant gap in 2019, highlight ongoing challenges that must be addressed to ensure equitable health outcomes. Additionally, the increase in inequalities based on the child's sex during the study period raises concerns about targeted interventions that may inadvertently neglect specific groups. These findings imply that policymakers must prioritize strategies that maintain high vaccination rates and focus on closing the geographical and sex-based gaps, particularly in underserved provinces and among vulnerable populations., Competing Interests: Declarations Ethics approval and consent to participate This study did not seek ethical clearance since the WHO HEAT software and the dataset are freely available in the public domain. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Clinical trial number Not applicable., (© 2024. The Author(s).)

Background: Vaccinating pediatric solid organ transplant candidates against measles and varicella is crucial due to the risk of severe disease in immunosuppressed recipients and general avoidance of live virus vaccines post-transplantation. The world saw a resurgence of measles starting 2012 prompting the American Society of Transplantation in 2015 to release guidelines on recognition, prevention, and post-exposure prophylaxis of this disease in solid transplant recipients. This study aims to assess the extent of incomplete immunity to these viruses in candidates and the approach to immunity optimization during a period of heightened awareness., Methods: A cross-sectional study from 2012 to 2016 at Cleveland Clinic Children's included pediatric solid organ transplant candidates. Data on vaccination history, serology, and demographics were collected. Incomplete immunity was defined by incomplete vaccination or seronegativity., Results: Among 91 candidates, 54.9% had complete varicella vaccination. Serological varicella immunity among patients tested varied by age: < 7 years, 50.0% positive in patients with complete schedules, none in the incomplete; ≥ 7 years, 50.0% positive in patients with complete schedules, 65.5% in the incomplete. For measles, 69.2% had complete vaccination, with immunity varying by age among those tested: < 7 years, 84.6% positive in patients with complete schedules, 42.9% in the incomplete; ≥ 7 years, 81.0% with complete, 62.5% with incomplete. Only 31.1% of those who qualified for a varicella additional dose and 28% who qualified for an additional measles dose received it, respectively., Conclusions: Incomplete immunity to varicella and measles was prevalent in pediatric solid organ transplant candidates at our center during the study period. Despite an increase in global measles activity, our efforts to optimize immunity through additional vaccine doses were only partially successful. Future research should focus on addressing strategies and understanding barriers to ensure timely vaccination for this vulnerable population prior to transplant, especially during periods of increased viral activity., (© 2024 The Author(s). Pediatric Transplantation published by Wiley Periodicals LLC.)

Objectives: Between 2003 and 2019, three trials (randomised controlled trials [RCTs]) in Guinea-Bissau randomised infants to an early 2-dose measles vaccine (MV) schedule at 4 and 9 months vs standard MV at 9 months. The RCTs produced contradictory mortality results; the effect being beneficial in the 2-dose group in the first but tending to have higher mortality in the last two RCTs. We hypothesised that increased frequency of campaigns with oral polio vaccine (C-OPV) explained the pattern., Methods: We performed per-protocol analysis of individual-level survival data from the three RCTs in Cox proportional hazards models yielding hazard ratios (HR) for the 2-dose vs the 1-dose MV group. We examined whether timing of C-OPVs and early administration of OPV0 (birth to day 14) affected the HRs for 2-dose/1-dose MV., Results: The combined HR(2-dose/1-dose) was 0.79 (95% confidence interval: 0.62-1.00) for children receiving no C-OPV-before-enrolment, but 1.39 (0.97-1.99) for those receiving C-OPV-before-enrolment (homogeneity, P = 0.01). C-OPV-before-enrolment had a beneficial effect in the 1-dose group but tended to have a negative effect in the 2-dose group, especially in females. These effects were amplified further by early administration of OPV0., Conclusion: In the absence of C-OPVs, an early 2-dose MV strategy had beneficial effects on mortality, but frequent C-OPVs may have benefitted the 1-dose group more than the 2-dose MV group, leading to varying results depending on the intensity of C-OPVs., Competing Interests: Declarations of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Nigeria has one of the highest measles burdens and the lowest vaccination coverage in the world. Geographical disparity in the coverage has also been persistent. Between 2019 and 2021, the Nigerian government introduced the second Measles vaccine (MCV2) into routine immunization (RI). This study evaluated the trends of the MCV2 coverage over time across geographical zones., Methods: The monthly data on the MCV2 coverage from District Health Information Software (DHIS2) for all the health facilities in Nigeria were aggregated by the geopolitical zone, and the trend of the MCV2 coverage was analyzed over time., Results: The MCV2 coverage in each zone was approximately 20% when the MCV2 program was launched. The MCV2 coverage was higher in the northern zones (35-42%) than in the southern zones (22-31%) 1 year after the launch. Similarly, at 2.5 years, the MCV2 coverage ranged from 38 to 46% in northern zones, while in southern zones, it ranged from 23 to 37%., Discussion and Conclusion: The introduction of MCV2 as part of the RI schedule potentially narrows down the health inequity in Nigeria., Competing Interests: The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sato.)

Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted essential health care services worldwide, including those related to immunisation. National data from Bangladesh shows that child immunisation may have been adversely affected by the pandemic but regional evidence is limited. We therefore aimed to explore the regional differences in the indirect effects of COVID-19 on child immunisation in Bangladesh., Methods: We extracted data from the District Health Information Software (DHIS2) spanning the period from January 2017 to December 2021. We examined three essential immunisation indicators: Bacille Calmette-Guérin (BCG), pentavalent third dose, and measles vaccinations. We examined both the yearly and monthly trends to explore fluctuations in the number of immunisations to pinpoint specific periods of service utilisation regression. Segmented regression with Poisson distribution was implemented given the count-based outcome. We reported incidence rate ratios (IRRs) with 95% confidence intervals (CIs) in different regions in 2020 and 2021 compared to the reference period (2017-19)., Results: We initially observed a notable decline in vaccine administration in April 2020 compared to the pre-pandemic period of 2017-19 with a drop of approximately 53% for BCG vaccines, 55% for pentavalent third doses, and 51% for measles vaccines followed by May 2020. The second half of 2020 saw an increase in vaccination numbers. There were noticeable regional disparities, with Sylhet (IRR = 0.75; 95% CI = 0.67-0.84 for pentavalent administration, IRR = 0.79; 95% CI = 0.71-0.88 for measles administration) and Chattogram (IRR = 0.77; 95% CI = 0.72-0.83 for BCG administration) experiencing the most significant reductions in 2020. In April 2020, Dhaka also experienced the largest decline of 67% in measles vaccination. In 2021, most divisions experienced a rebound in BCG and pentavalent administration, exceeding 2019 levels, except for Chittagong, where numbers continued to decline, falling below the 2019 figure., Conclusions: Our findings highlight the impact of the COVID-19 pandemic on childhood immunisation across regions in Bangladesh. Sylhet, Chattogram, and Dhaka divisions experienced the most significant reductions in immunisation services during 2020. This underscores the importance of targeted interventions and regional strategies to mitigate the indirect effects of future challenges on essential health care services, particularly childhood immunisation, in Bangladesh., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: The COVID-19 pandemic has led to decreased measles vaccination rates globally, exacerbating vaccine hesitancy. This study examines the relationship between COVID-19 vaccine acceptance and childhood measles vaccination among parents in Hong Kong., Methods: A cross-sectional online survey was conducted in Hong Kong from March to September 2022. Parents were recruited via the Qualtrics panel, and a total of 588 parents were invited via email or social media account to participate in the survey. We used the adjusted Measles-containing Vaccine Hesitancy Scale for the assessment of parental vaccine hesitancy for children. A multiple linear regression analysis was conducted to examine the association between parental acceptance of the COVID-19 vaccine and their attitudes towards childhood measles vaccination., Results: Of the 588 participants, parents who have been vaccinated against COVID-19 exhibited significantly less measles-containing vaccine hesitancy comparing to those unvaccinated (β = -2.96, 95% confidence interval [CI]: -5.10 to -0.83, p = 0.007). Mothers exhibited more hesitancy compared to fathers (β = 1.64, 95% CI: 0.60 to 2.68, p = 0.002). Parents with a higher self-rated health (β = -2.20, 95% CI: -3.21 to -1.20, p < 0.001), or who have received advice from health professionals to offer measles, influenza, or COVID-19 vaccines for kids (β = -2.41, 95% CI: -3.49 to -1.32, p < 0.001) had lower levels of hesitancy., Conclusion: COVID-19 vaccine status of parents was associated with reduced hesitancy towards measles vaccines for their children. Addressing vaccine hesitancy effectively requires targeted communication strategies, particularly focusing on those unvaccinated and leveraging the influence of healthcare professionals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Despite successful efforts to eliminate measles in Iran, imported measles cases continue to be reported. Because measles is endemic in neighboring countries. This research aims to evaluate the risk of measles transmission in different regions of Iran., Methods: Measles case-based surveillance data of the Expanded Program of Immunization containing 31 provinces and 463 districts from 2019 to 2021 were assessed. The WHO Measles Programmatic Risk Assessment tool was used to evaluate the risk of disease transmission in four domains: population immunity, surveillance quality, program delivery performance, and threat assessment. scores were categorized as low, medium, high, or very high risk., Results: During 2019-2021, the average incidence of measles was 1.9 per 1 million. Chabahar and Mashhad with 76 and ./6per million reported the highest and lowest incidence respectively. All 463 districts were categorized as low risk in risk assessment. Andimeshk, Chabahar, and Bojnurd obtained the highest risk scores with 27, 24, and 25 respectively. All districts were classified as low risk for population immunity. The average coverage of (MMR1) and (MMR2) was 95% or higher. All districts received the minimum points for surveillance quality., Conclusion: All regions are placed at a low level of disease transmission risk. However, the tool is not able to assess the risk at the rural or peripheral sectors level. The indicators used in this tool are the same for all countries with different epidemiological features (elimination, endemic). Sensitivity analysis can optimize the use of this tool for countries with different disease conditions., (© 2024. The Author(s).)

Introduction: Measles vaccination has greatly reduced the disease burden worldwide, but challenges remain due to variations in vaccine effectiveness across age groups. This study aimed to assess the serological profile of measles antibodies across different age groups, evaluate the impact of maternal immunity on antibody levels in infants under 12 months, and assess measles immunity in vaccinated individuals., Material and Methods: This cross-sectional study was conducted from June 2022 to January 2023 at the Children's Medical Center, a referral hospital in Iran. Serum samples were tested for measles-specific IgG and IgM antibodies using a commercial enzyme-linked immunosorbent assay (ELSA). An avidity assay was performed to assess measles virus-specific IgG antibodies on the samples that were positive and borderline for the measles IgG ELISA., Results: The study included 969 participants across various age groups. Among them, 23% (221 out of 953) tested positive for measles IgM ELISA, and 52% (504 out of 969) for measles IgG ELISA. Regarding the avidity assay for measles virus-specific IgG, the majority (418 out of 573, 73%) showed high-avidity antibodies. Measles-specific IgG levels varied significantly across different age groups, with infants below 6 months old showing a mean IgG level of 477 mIU/mL, declining to 230 mIU/mL between 6 and 12 months, and increasing significantly to 683 mIU/mL in the 12 to 18 month age group, reaching a peak at 938 mIU/mL among children aged 18-72 months., Conclusion: The increasing IgM positivity among young Iranians suggests a rising risk of measles outbreaks, possibly due to vaccination gaps. Inadequate antibody levels in infants raise concerns about vaccination effectiveness. Considering declining maternal antibodies, vaccinating infants at 6-9 months could be beneficial. Boosters for adolescents and women may further mitigate outbreak risks., Competing Interests: Declaration of competing interest The authors declared no conflicts of interest in connection with the research, authorship, and/or publication of this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Isolation of cases and quarantining of non-immune contacts are the mainstay of measles outbreak management in elimination settings. Serology testing of exposed contacts may not be feasible in large outbreaks; therefore, vaccination history is used as a proxy for determining immunity to measles and thus prevention of onward virus transmission. This study sought to investigate the risk of measles virus transmission from individuals with a history of one or two doses of measles-containing vaccine (MCV)., Methods:  Retrospective analysis of data from measles cases reported to Auckland Regional Public Health Service during the 2019 Auckland region measles outbreak. Vaccination history was verified using patient records and the New Zealand National Immunisation Register. Onward transmission was determined through case interviews and assessment of exposed contacts., Results:  1451 measles cases were assessed as eligible for vaccination at the time of measles outbreak. Of these, 1015 (70.0%) were unvaccinated, 220 (15.2%) had unknown vaccination status, 139 (9.6%) had received only one dose of MCV and 77 (5.3%) had received two doses of the vaccine. Compared to unvaccinated cases, the odds of onward transmission were lower among those with one dose only (OR 0.41, 95% CI: 0.20-0.75) or two doses of MCV (OR 0.44, 95% CI: 0.17-0.95). Median time since vaccination was longer among those with onward transmission compared to those without onward transmission for one and two doses of the vaccine, suggesting a potential effect of waning immunity among this cohort., Conclusion:  These findings support the hypothesis that measles cases with a history of prior vaccination are less likely to transmit the virus to others compared to unvaccinated cases. Such information can be used to support decisions around quarantine requirements for vaccinated contacts in future measles outbreaks., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. All authors attest they meet the ICMJE criteria for authorship., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Among people infected with measles in England between 2010 and 2019, the proportion of cases who had previously received two doses of vaccine has increased, especially among young adults. Possible explanations include rare infections in vaccinated individuals who did not gain immunity upon vaccination, made more common because fewer individuals in the population were born in the endemic era, before vaccination was introduced, and exposed as part of endemic transmission, or the waning of vaccine-induced immunity, which would present new challenges for measles control in near-elimination settings. We aimed to evaluate whether measles dynamics observed in England between 2010 and 2019 were in line with a waning of vaccine-induced immunity., Methods: We used a compartmental mathematical model stratified by age group, region, and vaccine status, fitted to individual-level case data reported in England from 2010 to 2019 and collected by the UK Health Security Agency. The deterministic model was fitted using Monte Carlo Markov Chains under three scenarios: without the waning of vaccine-induced immunity, with waning depending on time since vaccination, and with waning depending on time since vaccination, starting in 2000. We generated stochastic simulations from the fitted parameter sets to evaluate which scenarios could replicate the transmission dynamics observed in vaccinated cases in England., Findings: The scenario without waning overestimated the number of one-dose recipients among measles cases, and underestimated the number of two-dose recipients among cases older than 15 years (median 75 cases [95% simulation interval (SI) 44-124] in simulations without waning, 196 [95% SI 122-315] in simulations when waning was included, 188 [95% SI 118-301] in simulations when waning started in 2000, and 202 observed cases). The number of onward transmissions from vaccinated cases was 83% (95% credible interval 72-91%) of the number of transmissions from unvaccinated cases. The estimated waning rate was slow (0·039% per year of age; 95% credible interval 0·034-0·044% per year in the best-fitting scenario with waning starting in 2000), but sufficient to increase measles burden., Interpretation: Measles case dynamics in England are consistent with scenarios assuming the waning of vaccine-induced immunity. Since measles is highly infectious, slow waning leads to a heightened burden in outbreaks, increasing the number of measles cases in people who are both vaccinated and unvaccinated. Our findings show that although the vaccine remains highly protective against measles infections for decades and most transmission is connected to people who are unvaccinated, breakthrough infections are increasingly frequent for individuals aged 15 years and older who have been vaccinated twice., Funding: National Institute for Health and Care Research and Wellcome Trust., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Our report describes the characteristics of patients admitted to the intensive care unit of the National Hospital of Samoa during the 2019-2020 measles epidemic. The study design was a retrospective review of clinical records; the age range was 2 months to 51 years, with the majority of cases in the 2-23 month age group (71%). Vaccination status was unknown or unrecorded for 17 (24%). Of the 54 (75%) who were not fully vaccinated, 35 (65%) did not survive. Almost all (98%) presented with multiple complications on admission, mostly pneumonia (91%). The mortality rate was 61%, implying a low survival rate particularly among young infants and toddlers, even when optimal care was available and administered., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Measles is highly infectious, requiring ≥95% vaccine coverage rate (VCR) to prevent outbreaks. This study aimed to understand the impact of the COVID-19 pandemic on routine measles-containing vaccine (MCV) VCRs in Serbia and estimate national and regional catch-up vaccination required to prevent outbreaks., Methods: A multiplier model was used to calculate annual MCV dose 1 (MCV1) and MCV dose 2 (MCV2) VCRs for children 1-6 and 6-12 years of age, respectively, for 2011-2022. Postpandemic (2023-2024) VCRs were modeled. The numbers of administered doses were compared to prepandemic and postpandemic, and monthly catch-up rates were calculated for 12-, 18- and 24-month campaigns., Results: Between prepandemic and pandemic periods, national MCV1 VCR decreased from 88% to 81%, while MCV2 VCR decreased from 92% to 89%, corresponding to 20,856 missed MCV1 and 8760 missed MCV2 doses. Assuming national VCRs returned to prepandemic levels post-2022, 18% of children 1-6 years of age and 11% of children 6-12 years of age would have missed their MCV1 and MCV2 doses, respectively, by 2024. To catch up missed doses under this scenario, most regions would require monthly catch-up rates of 25%, 16% or 12% for MCV1 and 14%, 9% or 7% for MCV2, considering 12-, 18- or 24-month campaigns, respectively., Conclusions: The pandemic negatively impacted MCV VCRs in Serbia, leaving a sizeable proportion of children with missed doses. Significant catch-up efforts are required to recover VCRs to prepandemic levels and avoid future measles outbreaks, with increased monthly administration rates versus those in prepandemic periods., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Vaccine hesitancy is considered 1 of the top 10 threats to global health. This study aims to assess the impact of an education program on parents' attitudes toward the measles-rubella vaccine., Methods: A study was conducted with 250 parents using a randomized controlled trial design. The intervention group (125 parents) received training, education programs, and video, while the control group (125 parents) only received video. The Parent Attitudes about Childhood Vaccines (PACV) scale, including its behavior, safety and efficacy, and trust subscales, was used for pre-post assessment. This allowed for comparison between the groups and measurement of score differences. The PACV scale (range 0-42) identified vaccine hesitancy, with a score below 21 indicating "non-hesitant" and 21 or higher indicating "hesitant.", Results: The intervention group had a significant decrease in PACV scores after the program (17.54 ± 4.7, P = .001), mainly in behavior, safety, efficacy, and trust (6.4 ± 3.6, 9.8 ± 4.7, 3.9 ± 2; P = .001, .011, .002). The control group showed no changes (23.6 ± 3.5; P = .402). Postintervention PACV score differences were significant (t = 11.562, P = .001)., Discussion: Findings indicate that the education program had a positive effect on changing vaccine hesitancy., Conclusions: The education programs promoted vaccine acceptance among parents., (Copyright © 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: Recent years have seen increased cases of measles despite widespread vaccination. We examined the potential drivers behind the resurgence of measles., Methods: We analyzed the trends in measles incidence and vaccine coverage from 2010 to 2019 across World Health Organization member countries using country-level linear regression models. We computed the Spearman rank correlation coefficient (ρ) between measles incidence and socioeconomic and vaccination-related variables using published data from the World Health Organization member countries to identify the key factors influencing measles incidence., Results: Between 2010 and 2019, global measles cases fluctuated, with a notable rise in 2019 (measles cases per million in 2019 was about 140% higher than in 2010), alongside a declining vaccination coverage in many countries (59 of 194 countries). Among 10 socioeconomic factors examined, per-capita national gross income, population literacy, urban residences, and political stability were significantly associated with measles incidence (ρ <0, and P <0.05 for all these variables). These factors likely reflect the quality of public health infrastructure (e.g. access to vaccines), particularly, in low- and middle-income countries. In addition, a stratified analysis suggests vaccine hesitancy likely contributed to measles case increases in high- and upper middle-income countries., Conclusions: The socioeconomic determinants of measles transmission are interconnected and region-specific. The availability of public health resources and political stability significantly influence measles burdens in low- and middle-income countries, whereas vaccine hesitancy presents a unique challenge to measles elimination in high- and upper middle-income countries., Competing Interests: Declarations of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: As part of the Immunisation Agenda 2030, the World Health Organization set a goal to reduce the number of children who did not receive any routine vaccine by 50% by 2030. We aimed to describe the patterns of vaccines received for children with zero, one, and up to full vaccination, while considering newly deployed vaccines (pneumococcal conjugate vaccine (PCV) and rotavirus (ROTA) vaccine) alongside longstanding ones such as the Bacille Calmete-Guérin (BCG), diphtheria, tetanus, and pertussis (DPT), and poliomyelitis vaccines, and measles-containing vaccines (MCVs)., Methods: We used data from national household surveys (Demographic and Health Surveys and Multiple Indicator Cluster Surveys) carried out in 43 low- and middle-income countries since 2014. We calculated the immunisation cascade as a score ranging from zero to six, considering BCG, polio, DPT, and ROTA vaccines, and the MCV and PCV. We also described the most prevalent combination of vaccines. The analyses were pooled across countries and stratified by household wealth quintiles., Results: In the pooled analyses with all countries combined, 9.0% of children failed to receive any vaccines, 58.6% received at least one dose of each of the six vaccines, and 47.2% were fully vaccinated with all doses. Among the few children receiving 1-5 vaccines, the most frequent were BCG vaccines, polio vaccines, DPT vaccines, PCV, ROTA vaccines, and MCV., Conclusions: Targeting children with their initial vaccine is crucial, as those who receive a first vaccine are more likely to undergo subsequent vaccinations. Finding zero-dose children and starting their immunisation is essential to leaving no one behind during the era of Sustainable Development Goals., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare the following activities and relationships: TM and DHR are employed by Gavi, the Vaccine Alliance, the sponsor of this research. The remaining (BCP, TMS, LA, FC, CGV, and AJDB) declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views or policies of the institutions with which they are affiliated., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Background: Measles remains a major public health burden worldwide. Parents often hesitate to vaccinate children with chronic diseases. We investigated the association between the percentage of vaccination and chronic diseases and explore hospital infections' role in the 2017-2019 measles outbreak across northern Vietnam provinces., Methods: A total of 2,064 children aged 0-15 years old admitted for measles to the National Children's Hospital during the outbreak were included in the study. Demographic information, clinical characteristics, vaccination statuses and laboratory examination were extracted from electronic medical records, vaccination records, or interviews with parents when other sources were unavailable., Results: The incidence rate that provincial hospitals sent to the National Children's Hospital was proportional to the population density of their provinces of residence. Early nosocomial transmission of measles was observed before community-acquired cases emerged in many provinces. Among patients aged over 18 months, those with chronic diseases had a proportion of vaccination of 9.4%, lower than patients without chronic diseases at 32.4%. Unvaccinated patients had a higher proportion of hospital-acquired infections with aOR = 2.42 (1.65-3.65), p < 0.001 relative to vaccinated patients. The proportion of hospital-acquired infections was higher among children with chronic diseases compared to those without, with aOR = 3.81 (2.90-5.02), p < 0.001., Conclusion: Measles spread in healthcare settings prior to community cases that occurred in several provinces. We recommend enhancing hospital infection control by increasing staff training and improving early detection and isolation during non-outbreak periods. Measles patients with chronic diseases exhibited lower proportions of vaccination and faced a higher risk of hospital-acquired infections. It is crucial to establish comprehensive vaccination guidelines and enhance parental awareness regarding the significance and safety of measles vaccination to protect these vulnerable individuals., (© 2024. The Author(s).)

Background: Although a universal vaccine is available and Ethiopia is working outstandingly towards measles elimination, a recurrent measles outbreak has occurred each year in different parts of the country. Therefore, understanding the epidemiology of measles cases, the incidence of confirmed measles virus cases and related risk factors is crucial. Here, we conducted a systematic review and meta-analysis to summarize information regarding the epidemiology, measles incidence rate and risk factors for national measles infections occurring in the past two decades, from 2000 to 2023., Methods: Data from electronic databases, including PubMed, African Journal Online, WHO databases and Google Scholars, were searched to identify studies describing measles outbreaks, incidence rates and associated factors in Ethiopia that occurred between 2000 and 2023. Important basic information was extracted in an Excel spreadsheet and imported into Comprehensive Meta-analysis Software version 3 to evaluate the associations between measles outbreaks and different risk factors. We pooled the odds ratios (ORs) and 95% confidence intervals (CIs) for every included risk factor to evaluate the associations with measles outbreaks., Results: We included 36 studies involving 132,502 patients with confirmed measles cases in Ethiopia. The results of this systematic review and meta-analysis revealed that measles outbreaks were more frequently reported in the Oromia region (73,310 (33.1%)), followed by the Southern Nation Nationalities of Ethiopia region (29,057 (13.4%)). The overall pooled analysis indicated that the prevalence of measles susceptibility was 67.5% (95% CI: 67.3-67.8%), with an I 2 of 99.86% and a p value for heterogeneity < 0.0001. The non-vaccinated status of the children, their contact history with measles cases, their travel history, the presence of cases in family or neighbors, and malnourished patients were identified as factors associated with the high prevalence and recurrent measles infections in Ethiopia., Conclusion: The results of this systematic review and meta-analysis indicated that the pooled prevalence of measles infection was high, which is a public health concern in Ethiopia. Thus, strengthening healthcare services, regular vaccination campaigns, and the integration of health education activities with other services may decrease the incidence rate., (© 2024. The Author(s).)

Measles is a viral illness considered eliminated in the United States; however, outbreaks still occur even in this modern era where vaccines are readily available for every child under government-sponsored financing programs. The most recent measles outbreak was reported in March 2024 in Chicago, Illinois. Many of these patients were children younger than age 5 years with unvaccinated or unknown vaccine status, and this outbreak was associated with a migrant shelter. Measles bears a resemblance to other exanthemic diseases of childhood. In populations where there is high vaccine coverage, measles is less likely to be in the differential diagnosis for most physicians; however, cases of vaccine failure have been described, and populations have risk factors for developing complications associated with measles. Therefore, this quick review aims to describe an illustrative case, followed by epidemiology, clinical manifestations, complications, diagnosis, and vaccines associated with measles. By the end of this article, clinicians should be able to recognize a potential measles case, select the most appropriate test to confirm the diagnosis, and thus, prevent the spreading of this highly contagious disease. [ Pediatr Ann . 2024;53(9):e345-e350.] .

Background: Between 2000 and 2018, global measles deaths decreased by 73%, but the disease remains prevalent in many developing countries, especially in Africa and Asia. Although Ethiopia was attempting to eliminate the measles, it still ranks fourth in the world in terms of the number of cases. The aim of the investigation was to describe the outbreak and identify its determinants in the Aneded district., Methods: Between March 3, 2020, and April 2, 2020, the 89 patients and 178 controls participated in a case-control study. Data were gathered by means of in-person interviews with household leaders. The attack and case fatality rates were determined. In multivariable logistic regression analysis, variables having a p-value of less than 0.05 were considered statistically significant cut-off points., Results: An investigation was conducted on a total of 89 measles cases, with 3 deaths and 178 controls. In total, there were 1.65 attacks per 1000 people, or 3.4% of the case fatality rate. There were 155 days of outbreak duration. The disease was significantly associated with being female [adjusted odds ratios (AOR) = 2.66; 95% confidence interval (CI) = 1.38-5.11], under 5 years old [AOR = 7.24; 95% CI = 2.58-20.31], positive in attitude [AOR = 0.22; 95% CI = 0.11-0.42], and having a contact history [AOR = 3.19; 95% CI = 1.67-6.10]., Conclusion: The measles outbreak, with its higher attack and case fatality rate, has been influenced by factors like household attitudes, age, sex, contact and travel history and needs to be reduced through early detection, active surveillance, and fostering favorable attitudes towards disease prevention and control., (© 2024. The Author(s).)

Measles in persons with secondary vaccination failure (SVF) may be less infectious than cases in unvaccinated persons. Our systematic review aimed to assess transmission risk for measles after SVF. We searched PubMed, Embase, and Web of Science databases from their inception dates. Inclusion criteria were articles describing persons who were exposed to measles-infected persons who had experienced SVF. Across the included 14 studies, >3,030 persons were exposed to measles virus from SVF cases, of whom 180 were susceptible, indicating secondary attack rates of 0%-6.25%. We identified 109 cases of SVF from the studies; 10.09% (n = 11) of case-patients transmitted the virus, resulting in 23 further cases and yielding an effective reproduction number of 0.063 (95% CI 0.0-0.5). These findings suggest a remarkably low attack rate for SVF measles cases, suggesting that, In outbreak situations, public health management of unvaccinated persons could be prioritized over persons with SVF.

Nigeria has the highest burden of measles worldwide, as measles vaccine uptake remains low. Recently, the second dose of the measles-containing vaccine (MCV2) was introduced as part of the routine immunization (RI) program, and this study examined how it changed the uptake of the measles vaccine and the factors associated with vaccination behavior. The Nigeria Multiple Indicator Cluster Survey (MICS) 2021 was used to compare measles vaccination uptake as well as factors associated with vaccination uptake between children before MCV2 introduction (cohort 1) and after the introduction (cohort 2). The overall rate of measles vaccine uptake was higher among cohort 1 (64%-95%) than among cohort 2 (56%-92%) in all zones because of younger age among cohort 2. The dropout from the first to second measles vaccines was similar between the cohorts (around 24%). Higher maternal education levels and higher household wealth levels were both correlated with the vaccine uptake or both cohorts but a positive correlation between the dropout and mother's education level was observed only among cohort 2, especially in the North West and South West zones. The positive correlation between the dropout and mother's education level among cohort 2 indicates that the introduction of MCV2 as part of RI might have helped to narrow the disparity in measles vaccine uptake in North West and South West zones. Further study is required to investigate strategies employed to reduce the disparity in these zones to apply nationwide.

Social media platforms, including TikTok, have become influential sources of health information. However, they also present as potential sources for the spread of vaccine misinformation. The aim of this study was to assess the quality of measles-rubella (MR) vaccine-related contents on TikTok in Jordan and to analyze factors associated with vaccine misinformation. A systematic search for MR vaccine-related TikTok contents in Jordan was conducted using pre-defined keywords and a specified time range. Content metrics (likes, comments, shares, and saves) were collected while the content quality of health information was evaluated using a modified version of the DISCERN, a validated instrument by two expert raters. The average modified DISCERN score ranged from 1, denoting poor content, to 5, indicating excellent content. A total of 50 videos from 34 unique content creators formed the final study sample. The majority of MR vaccine-related content was created by lay individuals (61.8%), followed by TV/news websites/journalists (23.5%), and healthcare professionals (HCPs) (14.7%). The Cohen κ per modified DISCERN item was in the range of 0.579-0.808, p <0.001), indicating good to excellent agreement. The overall average modified DISCERN score was 2±1.2, while it was only 1.3±0.52 for lay individuals' content, which indicated poor content quality. For the normalized per number of followers for each source, content by lay individuals had a significantly higher number of likes, saves, and shares with p =0.009, 0.012, and 0.004, respectively. Vaccine misinformation was detected in 58.8% of the videos as follows: lay individuals (85.7%), TV/news websites/journalists (25.0%), and HCPs content had none ( p <0.001). Normalized per the number of followers for each source, videos flagged as having MR vaccine misinformation reached a higher number of likes, saves, and shares ( p =0.012, 0.016, and 0.003, respectively). In conclusion, substantial dissemination of TikTok MR vaccine-related misinformation in Jordan was detected. Rigorous fact-checking is warranted by the platform to address misinformation on TikTok, which is vital to improve trust in MR vaccination and ultimately protect public health., Competing Interests: All the authors declare that there are no conflicts of interest., (© 2024 The Author(s).)

Purpose: Despite substantial vaccination progress, persistent measles outbreaks challenge global elimination efforts, particularly within healthcare settings. In this paper, we critically review the factors contributing to measles outbreak and effective control measures for nosocomial transmission of measles., Methods: We systematically searched electronic databases for articles up to 17th May, 2023. This was performed by two independent reviewers, with any disagreements resolved by a third reviewer. We also searched governmental and international health agencies for relevant studies., Results: Forty relevant articles were systematically reviewed, revealing key factors fuelling measles outbreak in healthcare settings, including high transmissibility capability; high intensity exposure; delayed care; failure to use protective equipment and implement control measures; vaccine failure; unclear immunisation history and lack of registries; and lacking recommendation on healthcare workers' (HCWs) measles vaccination. To combat these challenges, successful control strategies were identified which include early notification of outbreak and contact tracing; triaging all cases and setting up dedicated isolation unit; strengthening protective equipment use and physical measures; improving case detection; determining immunity status of HCWs; establishing policy for measles vaccination for HCWs; management of exposed personnel; and developing a pre-incident response plan., Conclusion: A coordinated and comprehensive approach is essential to promptly identify and manage measles cases within healthcare settings, necessitating multifactorial strategies tailored to individual settings. These findings provide a valuable foundation for refining strategies to achieve and maintain measles elimination status in healthcare environments., (© 2024. The Author(s).)

Background and Objectives: In a highly vaccinated population, an increasing number of previously vaccinated measles cases can be expected. The aim of this study was to assess the effect of vaccination on the clinical course and immune response in relation to the current measles case definition., Methods: The presence of fever, catarrhal symptoms, exanthema and complications, and specific IgM and IgG positivity were assessed in all 230 patients and compared in 193 patients with known vaccination status, divided into measles-containing vaccine (MCV) groups: MCV0 (85 patients), MCV1 (25 patients) and MCV2 (83 patients)., Results: Statistically significant differences between groups were found for catarrhal symptoms. Conjunctivitis and rhinitis were significantly less frequent in the MCV2 group (47% and 54%) compared to MCV0 (80% and 80%), p  < 0.001 and p  = 0.002 respectively. Typical exanthema was present in 74 (87%) MCV0 and 56 (67%) MCV2 patients, p  = 0.005. Complications were most common in the MCV0 group (29%). ECDC clinical case criteria were met in 81 (95%) MCV0, 18 (72%) MCV1 and 59 (71%) MCV2 patients, p  < 0.001. IgM were positive in 64 (83%) MCV0, 14 (74%) MCV1 and 36 (67%) MCV2 patients, differences were not statistically significant. There were highly significant differences in IgG between MCV0 and both vaccinated groups ( p  < 0.001)., Conclusions: A redefinition of the clinical case classification is essential to better capture modified measles and to raise awareness among healthcare workers of the differences in measles in vaccinated patients.

Background: Measles is one of the leading causes of under-five mortality and morbidity worldwide. Although the routine service for the second dose of the measles-containing vaccine (MCV2) was introduced in Ethiopia recently, there is a paucity of evidence regarding its coverage and the factors that hinder its uptake at both the local and national levels. Thus, this study aimed to assess the uptake of MCV2 and its associated factors among children aged between 15 and 36 months old in Jigjiga City, Somali Region, Ethiopia., Methods: A community-based cross-sectional study was conducted among 429 children aged between 15 and 36 months old with their mothers/caregivers in Jigjiga City from April 1 to May 1, 2023. A multistage sampling technique was used and data were collected by using structured interviewer-administered questionnaires. The collected data were entered into Epi-data version 3.2 and analyzed in a statistical package for the social sciences (SPSS) version 26. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with the uptake of the measles second dose vaccine. An adjusted odds ratio with 95% CI were reported and statistical significance was declared at p  < 0.05., Results: The coverage of MCV2 among children aged between 15 and 36 months was 21.4% (95% CI: 17.7, 25.2). The educational status of the mother (AOR = 3.154; 95% CI: 1.68, 5.93), place of delivery (AOR = 1.90; 95% CI: 1.08, 3.25), postnatal care visits of the mother (AOR = 2.40; 95% CI: 1.37, 4.22), time taken to reach a health facility (AOR = 2.67; 95% CI: 1.28, 5.57), and knowledge about child vaccination (AOR = 2.43; 95% CI: 1.45, 4.08) were factors significantly associated with the uptake of the measles second dose vaccine., Conclusion: The coverage of MCV2 in the study area was low compared to the national immunization targets. Educational status of the mother/caregivers, place of delivery, postnatal care visits of the mother, time to reach a health facility, and knowledge about vaccination of children were significantly associated with measles second dose vaccination. The focus should be given to improving the awareness of mothers on the importance of child vaccination to improve the uptake of measles second dose vaccine and reduce the burden of measles in the region., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ibrahim, Wariyo, Asefa, Cheru, Abebe Lonsako and Dirirsa.)

Background: Each year, vaccine-preventable diseases cost the lives of 8.8 million under-five children. Although vaccination prevents 1-2 million childhood deaths worldwide, measles vaccination dropouts are not well studied in developing countries, particularly in Ethiopia. Therefore, this study aims to assess the spatial distribution of the measles vaccination dropout and its determinants among under-five children in Ethiopia., Methods: Data from Ethiopian Demographic and Health Survey 2019 was used for data analysis. The study used a total of 5,753 children. Spatial autocorrelations was used to determine the spatial dependency of measles vaccination dropout. Ordinary interpolation was employed to forecast measles vaccination dropout. Factors associated with measles vaccination dropout were declared significant at p-values <0.05. The data were interpreted using the confidence interval and adjusted odds ratio. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model., Results: In Ethiopia, one in three under-five children had measles vaccination dropouts. Factors such as birth interval (AOR = 1.87, 95% CI: 1.30, 2.70), unmarried marital status women (AOR = 3.98, 95% CI: 1.08, 8.45), ≤1 number of under-five children (AOR = 3.86, 95% CI: 2.56, 5.81), rural place of residence (AOR = 2.43, 95% CI: 2.29, 3.11), low community-level ANC utilization (AOR = 3.20, 95% CI: 2.53, 3.56), and residing in Benishangul Gumuz (AOR = 1.80, 95% CI: 1.061, 3.06) had higher odds of measles vaccination dropout., Conclusions: Measles vaccination dropout rates in Ethiopia among under-five children were high compared to the maximum tolerable vaccination dropout level of 10% by the WHO. Both individual and community-level variables were determinants of measles vaccination dropout. The ministry of health in Ethiopia should give attention to those mothers of under-five children who reported underutilization of ANC services and rural residences while designing policies and strategies in areas of high spatial clustering of vaccine dropout in Ethiopia., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Zegeye et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Competing Interests: AH, VH, SH, PK, SD, and AR were responsible for the original design and preparation of this Correspondence. AS and NP collated and analysed the secondary immunodeficiency cohort measles and clinical data and contributed to the writing of the Correspondence and figures and table preparation. SF was responsible for the measles testing of the COCO cohort, analysis of birth groups, and figure and table preparation. OG was responsible for the measles testing of the VIBRANT cohort, analysis, and contributed to writing of the Correspondence. AS and AR have accessed and verified all underlying data. All authors had full access to the data in the Correspondence and had final responsibility for the decision to submit for publication. We declare no competing interests related to this Correspondence. AH has received unrelated grant funding from Wellcome Trust, Medical Research Council (MRC), British Society for Antimicrobial Chemotherapy, and Medical Research Foundation. AH acts as a clinical consultant for the WHO Global Influenza Programme, Department of Health and Social Care Scientific Advisory Group for Serology Testing, National Institute for Clinical Excellence, and Scotland Medicines consortium; and is a data monitoring committee member for the BALANCE trial (NCT03005145). AR has received unrelated grant funding from UK Research and Innovation (UKRI) and MRC. SD has received unrelated grant funding from MRC, UKRI, National Institute for Health and Care Research, and Wellcome Trust. VH has received unrelated grant funding from MRC and Health Data Research UK, and is supported by the UK Health Security Agency and the UK Department of Health. The authors welcome applications from researchers looking to use the data published herein. Applications should be directed to the corresponding author and will be reviewed by the authorship group and subject to the establishment of data sharing agreements. This work is a compilation from three different studies and four different funding sources where data on measles immunity has been tested as part of the study and then combined to provide the narrative in this Correspondence. The COCO study was funded by the UK Medical Research Council. The VIBRANT and SIREN studies were funded by UK Research & Innovation COVID-19 Rapid Response Initiative. Laboratory validation and verification of the measles ELISAs was supported by funding from the UK Medical Research Council (MX/X502996/1). Relevant Ethics committee approvals were from Camden and Kings Cross Research Ethics Committee (20/HRA/1817) for the COCO study and the Chelsea Research Ethics Committee (21/HRA/5433) for the VIBRANT study.

Measles remains a major threat to human health despite widespread vaccination. While we know that maternal antibodies can impair vaccine-induced immunity, the relative contributions of pre-existing immunity levels, maternal and infant characteristics on vaccine responses remain unclear, hampering evidence-based vaccination policy development. Here we combine serological data from 1,505 individuals (aged 0-12 years) in a mother-infant cohort and in a child cohort with empirical models to reconstruct antibody trajectories from birth. We show that while highly heterogeneous across a population, measles antibody evolution is strongly predictive from birth at the individual level, including following vaccination. Further, we find that caesarean section births were linked with 2.56 (95% confidence interval: 1.06-6.37) increased odds of primary vaccine failure, highlighting the long-term immunological consequences of birth route. Finally, we use our new understanding of antibody evolution to critically assess the population-level consequences of different vaccination schedules, the results of which will allow country-level evaluations of vaccine policy., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Vietnam continues to have measles and rubella outbreaks following supplementary immunization activities (SIA) and routine immunization despite both having high reported coverage. To evaluate immunization activities, age-specific immunity against measles and rubella, and the number of averted Congenital Rubella Syndrome (CRS) cases, must be estimated., Methods: Dried blood spots were collected from 2091 randomly selected individuals aged 1-39 years. Measles and rubella virus-specific immunoglobulin G (IgG) were measured by enzyme immunoassay. Results were considered positive at ≥120 mIU/mL for measles and ≥10 IU/mL for rubella. The number of CRS cases averted by immunization since 2014 were estimated using mathematical modelling., Results: Overall IgG seroprevalence was 99.7% (95%CI: 99.2-99.9) for measles and 83.6% (95%CI: 79.3-87.1) for rubella. Rubella IgG seroprevalence was higher among age groups targeted in the SIA than in non-targeted young adults (95.4% [95%CI: 92.9-97.0] vs 72.4% [95%CI: 63.1-80.1]; P < 0.001). The estimated number of CRS cases averted in 2019 by immunization activities since 2014 ranged from 126 (95%CI: 0-460) to 883 (95%CI: 0-2271) depending on the assumed postvaccination reduction in the force of infection., Conclusions: The results suggest the SIA was effective, while young adults born before 1998 who remain unprotected for rubella require further vaccination., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction. At the end of 2019 and the year before, there was a significant spread of measles in the World Health Organization (WHO) European Region. Gap statement. Among the countries that reported, a measles outbreak was Bosnia and Herzegovina (BiH). Aim. To describe the measles outbreak in BiH (an entity of the Federation of BiH, FBiH) in 2019. Methodology. Confirmatory IgM serology, measles nucleic acid detection by real-time RT-PCR and virus genotyping were done in the WHO-accredited laboratory for measles and rubella at the Clinical Center of the University of Sarajevo, Unit for Clinical Microbiology. Genotype was determined in all measles-RNA-positive cases by sequence analysis of the 450 nt fragment coding the C-terminal of measles virus nucleoprotein (N). Results. From 1 January to 31 December 2019, 1332 measles cases were reported, with the peak observed in April 2019 (413/1332, 31.01 %). Sarajevo Canton had the highest incidence, number of cases and percentage (206.4; 868/1332; 65.17 %) of measles cases. Around four-fifths of infected persons were unvaccinated (1086/1332, 81.53 %), while 4.58 % of the patients (61/1332) were immunized with one dose of measles-containing vaccine. The highest proportion of cases was found in children 0-6 years of age (738/1332, 55.41 %). Measles IgM positivity was determined in 75.88 % (346/456), while virus RNA was detected in 82.46 % (47/57) of the swab samples. All measles virus sequences belonged to genotype B3. SNP (position 216: C=>T) was detected in 1 of the 40 sequences obtained during this outbreak. Conclusion. Due to suboptimal immunization coverage, BiH belongs to countries at a high risk for measles outbreaks. Post-COVID-19 (coronavirus disease 2019) pandemic, targeted and tailored strategies are required to ensure routine vaccination demand and acceptance and broad partner and stakeholder group participation.

Introduction: Measles remains a critical public health concern causing significant morbidity and mortality globally. Despite the success of measles vaccination programs, challenges persist, particularly in India. This study investigates dose-wise measles vaccination coverage and explores gaps in immunization focusing on zero-dose, one-dose, and two-dose coverage among children aged 24-35 months., Data Sources and Methodology: The National Family Health Survey 2019-21 (NFHS-5) served as the data source and the study analyzed information from 43,864 children aged 24-35 months. Sociodemographic variables such as birth order, wealth quintile, gender, social group, religion, residence, mother education, delivery-related factors, and media exposure were considered. Statistical analysis involved weighted estimates, chi-square tests, and multivariate multinomial logistic regression., Results: The study revealed that challenges persist in achieving optimal measles vaccination coverage. Analysis by sociodemographic factors highlighted disparities in coverage, with variations in zero dose prevalence across states and districts. The percentage of zero-dose children was significantly higher, with 11.5% of children in India remaining to receive any measles vaccination. Factors influencing vaccine coverage include birth order, age, wealth quintile, social group, religion, residence, maternal education, place of delivery, media exposure, and mode of delivery. The findings from the spatial analysis show the clustering of zero-dose children is high in the northeastern states of India., Discussion: Measles zero-dose children pose a significant obstacle to achieving elimination goals. Spatial analysis identifies clusters of unvaccinated populations guiding targeted interventions. The study aligns with global initiatives such as the Immunization Agenda 2030 emphasizing equitable vaccine access and discusses how India can tailor its strategies to achieve the goal. Lessons from polio eradication efforts inform strategies for measles elimination, stressing the importance of high-quality data and surveillance. The study underscores the urgency of addressing last-mile measles vaccination gaps in India. Spatially targeted interventions informed by sociodemographic factors can enhance immunization coverage. Achieving measles elimination requires sustained efforts and leveraging lessons from successful vaccination campaigns. The study findings have the potential to contribute to informed decision-making, supporting India's roadmap for the measles and rubella elimination goal., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Pritu Dhalaria reports financial support was provided by Bill & Melinda Gates Foundation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)