Measles: prospects of vaccine prophylaxis and decrease of morbidity in Moscow

The results of the prolonged epidemiological surveillance on measles in Moscow are presented. The detailed analysis of the influence of immunization on the level of measles morbidity has been made. Changes in the age structure of measles patients with an essential increase in the proportion of adolescents and adults due to mass vaccination of the child population are shown. High risk groups have been determined according to the data of serological screening and epidemiological surveillance. The prospects of the vaccinal prophylaxis of measles under present conditions, as the basic intervention for achieving sporadic level of morbidity in this infection and further eradication are evaluated.     

佛山市南海区2004—2010年麻疹流行病学特征分析及控制策略探讨

了解佛山市南海区2004—2010年麻疹流行病学特征,为进一步完善和制订消除麻疹策略与措施提供科学依据。采用流行病学方法对佛山市南海区2004—2010年麻疹发病资料进行分析。结果显示,佛山市南海区2004—2010年累计确诊麻疹病例1 376例,年平均发病率为9.24/10万;全年均有发病,3～8月是麻疹高发季节,但近年来随着麻疹防控措施的落实,季节性已不明显;麻疹发病以5岁以下儿童为主,占总发病数的55.7%,,近年来麻疹发病年龄趋势向<1岁人群组和≥15岁人群组发展,这两个年龄组发病数占总发病人数的62.8%;病例中无免疫史或免疫史不详者占92.2%。佛山市南海区麻疹发病年龄分布已逐步呈现"双向位移"现象,加强对重点人群、重点地区的免疫规划管理,提高麻疹疫苗接种率,是控制麻疹发病的有效措施。同时适时开展强化免疫接种是保护易感人群,进而实现消除麻疹的重要策略.     

Model of the spreading dynamics of a hospital infection

The article deals with the epidemiological model and the corresponding mathematical model of the spread of hospital infection. The mathematical apparatus of Markov's heterogeneous chain is used. The model may be used for the analysis and planning of antiepidemic measures, as well as for the evaluation of their effectiveness. The conditions for the possibility of the application of the newly developed mathematical model have been formulated. The method for calculating the parameters of the model on the basis of data on morbidity in different forms of hospital infection is presented. An example of using the above model for the analysis of the data of observation is considered in detail.     

Study of the effect of vaccination on periodic structures of measles epidemics in Japan

The purpose of this paper is to investigate the effect of vaccination on periodic structures of measles epidemics in Japan. We carried out spectral analysis for time series data of measles notifications collected in Japan. It was confirmed that the interepidemic period, which corresponds to the interval between major epidemics of measles, increases as the vaccination ratio increases. This result was supported by a theory based on a mathematical model for epidemics of infectious diseases. It was suggested that the interepidemic period is useful to estimate the effect of vaccination on measles incidences quantitatively.     

深圳市南山区西丽人民医院辖区2005-2009年麻疹疫情分析

为了掌握深圳市南山区西丽人民医院辖区内麻疹病毒流行现状,评价该院辖区麻疹疫苗接种效果,为今后制订麻疹预防控制策略提供依据。采用回顾性调查方法,将2005-2009年间的麻疹发病情况作了分析。2005、2007两年发病人数最多,发病率较高,随着麻疹疫苗强化免疫活动的开展,使疫情有了较大的下降趋势。结果表明,接种麻疹疫苗是最有效地预防麻疹疫情的手段。     

Epidemiologic effectiveness of mass revaccination against measles

The data on the epidemiological effectiveness of the mass booster immunization of students of high schools, as well as professional and technical schools, against measles are presented. Booster immunization is considered to be a highly effective antiepidemic measure aimed at decreasing morbidity rate in measles.     

Considering human-primate transmission of measles virus through the prism of risk analysis

Measles is a respiratory virus that is endemic to humans. Human-nonhuman primate (NHP) transmission of the measles virus has been shown to cause significant morbidity and mortality in NHP populations. We investigated serological evidence of exposure to measles virus in two free-ranging populations of macaques at the Bukit Timah (BTNR) and Central Catchment Nature (CCNR) reserves in Singapore and the Swoyambhu Temple in Katmandu, Nepal. At BTNR/CCNR none of the 38 macaques (Macaca fascicularis) sampled were seropositive for antibodies to measles virus. In contrast, at Swoyambhu 100% (n = 39) of the macaques (M. mulatta) sampled were seropositive for antibodies to the measles virus. Here the contrasting seroprevalences of the two sites are analyzed using risk analysis. These case studies show how risk analysis can be used to approach the phenomenon of cross-species pathogen transmission.     

Measles virus-induced immune suppression in the cotton rat (Sigmodon hispidus) model depends on viral glycoproteins.

Immune suppression during measles accounts for most of the morbidity and mortality associated with the virus infection. Experimental study of this phenomenon has been hampered by the lack of a suitable animal model. We have used the cotton rat to demonstrate that mitogen-induced proliferation of spleen cells from measles virus-infected animals is impaired. Proliferation inhibition is seen in all lymphocyte subsets and is not dependent on viral replication. Cells which express the viral glycoproteins (hemagglutinin and fusion protein) transiently by transfection induce proliferation inhibition after intraperitoneal inoculation, whereas application of a recombinant measles virus in which measles virus glycoproteins are replaced with the vesicular stomatitis virus G protein does not have an antiproliferative effect. Therefore, in vivo expression of measles virus glycoproteins is sufficient and necessary to induce inhibition of lymphocyte proliferation.     

Vitamin A supplementation in infectious diseases: a meta-analysis.

OBJECTIVE--To study the effect of vitamin A supplementation on morbidity and mortality from infectious disease. DESIGN--A meta-analysis aimed at identifying and combining mortality and morbidity data from all randomised controlled trials of vitamin A. RESULTS--Of 20 controlled trials identified, 12 trials were randomised trials and provided "intention to treat" data: six community trials in developing countries, three in children admitted to hospital with measles, and three in very low birth weight infants. Combined results for community studies suggest a reduction of 30% (95% confidence interval 21% to 38%; two tailed p < 0.0000001) in all cause mortality. Analysis of cause specific mortality showed a reduction in deaths from diarrhoeal disease (in community studies) by 39% (24% to 50%; two tailed p < 0.00001); from respiratory disease (in measles studies) by 70% (15% to 90%; two tailed p = 0.02); and from other causes of death (in community studies) by 34% (15% to 48%; two tailed p = 0.001). Reductions in morbidity were consistent with the findings for mortality, but fewer data were available. CONCLUSIONS--Adequate supply of vitamin A, either through supplementation or adequate diet, has a major role in preventing morbidity and mortality in children in developing countries. In developed countries vitamin A may also have a role in those with life threatening infections such as measles and those who may have a relative deficiency, such as premature infants.     

104例麻疹病例的流行病学分析

目的分析平顶山市麻疹病例发生的原因,为加速控制和消除麻疹提供科学依据。方法对平顶山市2013年法定传染病疫情报告资料和麻疹监测资料进行流行病学分析。结果平顶山市2013年共报告麻疹104例,年发病率为2.11/10万,2~4月为发病高峰;男女发病率差异有统计学意义,发病以3岁以下儿童居多,占发病总数的86.54%;其中8月龄~1岁者最多,占39.42%;14岁以上者9例,占8.65%,其他年龄组发病率随年龄增大而逐步下降。从病例就诊、住院时间上推断其感染方式可能以医院内感染为主。结论常规免疫接种率和首针及时接种率不高是麻疹高发的主要原因,医院内交叉感染是麻疹的传播因素,提高易感人群麻疹疫苗接种率,控制院内感染是控制、消除麻疹的有效手段。     

Economic effectiveness of using a live measles vaccine in an agricultural area of the Ukrainian SSR

Economic effectiveness of vaccination against measles in an agricultural region of the Ukrainian SSR has been studied. At the period preceding vaccination expenses for each measles patient in the country were three times as low as those in towns. At the period of vaccination a considerable decrease in expenses covering the payment of sick-leave certificates given to mothers taking care of their sick children, in losses connected with absenteeism, in expenses for gamma globulin prophylaxis and the hospital treatment and outpatient servicing of measles patients was observed due to the sharp drop of the total morbidity rate and the increased number of school children among measles patients. In urban and rural areas the equalization of expenses for each patient occurred. In spite of increased expenses for each measles patient, the considerable economy of sums spent for controlling measles was achieved: about 70,000 rubles per annum.     

On the epidemiological situation in quarantine, natural focal and other infections on the territory of the Southern Federal District

The data on the sanitary and epidemiological situation in the Southern Federal District are presented. The analysis of morbidity in tuberculosis, measles, HIV infection, viral hepatitis A, typhoid fever, cholera and quarantine infections, Crimean hemorrhagic fever, West Nile fever, rabies, malaria has been carried out. Special attention has been given to "new and newly returning infections", and among them to the spread of SARS ("atypical pneumonia"). The role of regional epidemiological safety programs, in particular such program as "The prophylaxis of quarantine and natural focal infections and the sanitary protection of the territory of the Southern Federal District of the Russian Federation from the import and spread infectious diseases in 2003-2005", has been substantiated.     

Suppression of in vitro lymphocyte responsiveness to purified protein derivative by measles virus. A reexploration of the phenomenon.

Clinical measles and measles vaccination have classically been associated with transient in vivo impairment of delayed hypersensitivity-type responses, especially skin test reactivity to purified protein derivative (PPD). In vitro data appeared to substantiate this in vivo observation by the demonstration of suppression of lymphocyte responsiveness to PPD by measles. Utilizing a measles preparation which has been recently demonstrated to elicit specific blastogenesis of sensitized human lymphocytes in vitro, we have reexplored the question of in vitro suppression of lymphocyte responsiveness to PPD by this virus. In contrast to previous reports, this study demonstrates that the addition of both measles and PPD to lymphocyte cultures can have a variable effect on lymphocyte responsiveness to PPD alone. This effect varies from marked inhibition to enhancement beyond a summation effect. The response is different for each lymphocyte donor and is dose related but cannot be predicted on the basis of combinations of high or low concentrations of either antigen. Purified, attenuated measles virus (Enders' strain), which uniformly suppressed in vitro lymphocyte reactivity when tested alone also demonstrated a significant dose related enhancement of the response to PPD alone. The present data suggest a reconsideration of the supposed importance of transient diminution of skin test reactivity during measles infection or immunization.     

许昌市2010年麻疹疫情分析

研究许昌市麻疹流行特征,为消除麻疹提供科学依据.对许昌市2010年麻疹疫情进行描述流行病学分析.结果显示2010年全市共报告麻疹确诊病例158例,报告发病率为3.74/10万;流行毒株为麻疹病毒H1a基因型.3-5月份是发病高峰;0～3岁龄儿童为主,其中小于8月龄病例占报告发病数的32.91％;8- 17月龄病例,68...     

甘肃省麻疹监测系统报告病例的流行病学分析

目的分析甘肃省近年来麻疹报告发病特点,为实现消除麻疹目标措施的制定提供参考依据。方法对甘肃省2009—2010年疾病监测信息报告系统和麻疹监测系统报告的疑似麻疹病例进行分析。结果 2009—2010年报告麻疹病例1 463例,主要集中在15岁以下年龄组,占病例总数的74.16%,≥15岁病例占病例总数的25.91%。4～7月为发病的高峰季节。对15岁以下进行流行病学调查的病例分析,20.86%的病例未接种过麻疹类疫苗,32.71%的病例免疫史不详。对病例的接触史分析,在发病前7～21d有5.82%的病例明确接触过发热出疹性病人,有12.43%的病例曾去过医院。分离出麻疹病毒H1a基因型,对麻疹疫苗免疫和疫情的防控有指导意义。结论根据麻疹发病年龄构成及免疫史分析,个别地区常规免疫接种不足是造成麻疹发病的主要原因,同时要注意控制院内感染的发生。需要在提高麻疹疫苗常规免疫覆盖率的基础上,进一步深入和规范监测工作,提高监测调查质量。     

Measles morbidity among children inoculated against this infection

In the serological survey of 2009 children immunized against measles 285 children (14.2%) were found to be seronegative to this infection in the hemagglutination inhibition test with 4 hemagglutinating units of the antigen. Among 1724 immunized children showing positive response to vaccination and placed under dynamic observation for 11 years, 2 cases of measles were registered. At the same time, in the dynamic observation of 111 seronegative children 66 measles cases (59.5%) were registered during the above period, while among 169 children, also seronegative, but receiving booster immunization against measles, morbidity rate was only 1.2%. In some vaccinees the decrease of postvaccinal immunity to seronegative values was observed, but such decrease had no essential influence on the morbidity level among the vaccines. The increase of measles morbidity among schoolchildren immunized against this infection was due not to the decrease of their postvaccinal immunity, but to their concentration in schools and to their more intensive contacts with the sources of infection in comparison with children of preschool age.     

Quantitative research on the cyclic fluctuations of the epidemic process in a number of infectious diseases in Bulgaria

The cyclic nature of the epidemic process in Bulgaria was studied by various methods (spectral analysis, etc.), forming a system. The morbidity dynamics in 10 infectious diseases (scarlet fever, rubella, measles, epidemic parotitis, whooping cough, diphtheria, typhoid fever, enterocolitis, bacterial dysentery, viral hepatitis) over the years of 1909-1983 were studied and cycles covering the periods of 3-4, 5-6, 10-11 and over 16 years were established. The data on the relative part of cyclic processes in the registered morbidity of infectious diseases, as well as information on the prognostication of the spread of infections in the absence of vaccinal prophylaxis, are presented.     

The Evolutionary and Epidemiological Dynamics of the Paramyxoviridae

Paramyxoviruses are responsible for considerable disease burden in human and wildlife populations: measles and mumps continue to affect the health of children worldwide, while canine distemper virus causes serious morbidity and mortality in a wide range of mammalian species. Although these viruses have been studied extensively at both the epidemiological and the phylogenetic scales, little has been done to integrate these two types of data. Using a Bayesian coalescent approach, we infer the evolutionary and epidemiological dynamics of measles, mumps and canine distemper viruses. Our analysis yielded data on viral substitution rates, the time to common ancestry, and elements of their demographic history. Estimates of rates of evolutionary change were similar to those observed in other RNA viruses, ranging from 6.585 to 11.350 × 10⁻⁴ nucleotide substitutions per site, per year. Strikingly, the mean Time to the Most Recent Common Ancestor (TMRCA) was both similar and very recent among the viruses studied, ranging from only 58 to 91 years (1908 to 1943). Worldwide, the paramyxoviruses studied here have maintained a relatively constant level of genetic diversity. However, detailed heterchronous samples illustrate more complex dynamics in some epidemic populations, and the relatively low levels of genetic diversity (population size) in all three viruses is likely to reflect the population bottlenecks that follow recurrent outbreaks.     

Extracting the time-dependent transmission rate from infection data via solution of an inverse ODE problem

The transmission rate of many acute infectious diseases varies significantly in time, but the underlying mechanisms are usually uncertain. They may include seasonal changes in the environment, contact rate, immune system response, etc. The transmission rate has been thought difficult to measure directly. We present a new algorithm to compute the time-dependent transmission rate directly from prevalence data, which makes no assumptions about the number of susceptible or vital rates. The algorithm follows our complete and explicit solution of a mathematical inverse problem for SIR-type transmission models. We prove that almost any infection profile can be perfectly fitted by an SIR model with variable transmission rate. This clearly shows a serious danger of overfitting such transmission models. We illustrate the algorithm with historic UK measles data and our observations support the common belief that measles transmission was predominantly driven by school contacts.