Difficulties in Eliminating Measles and Controlling Rubella and Mumps: A Cross-Sectional Study of a First Measles and Rubella Vaccination and a Second Measles, Mumps, and Rubella Vaccination

Abstract

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

A 16-year review of seroprevalence studies on measles and rubella

“…Considering these situations, alternative vaccination schedules for infants have been postulated, including vaccinating earlier, e.g. at 8 months of age [25,30,88,91]. Others suggest that delaying vaccination until 14 months of age [20] would enable the infant's immune system to develop, thereby producing a better immune response.…”

Planning and preparation for pregnancy among women with and without a history of infertility

“…High percentage of abnormal results among studied patients confirm the need to perform a urine culture test to detect asymptomatic bacteriuria, which is a known risk factor for both preterm delivery and low birth weight [16]. It strongly proves that urine testing should be performed routinely in all pregnant women regardless of the presence of symptoms.…”

“…These results are unacceptable considering the fact that maternal anemia may be associated with significantly increased risk of low birth weight and low Apgar score [16]. Moreover, low hemoglobin concentration in the first trimester of gestation seems to have the most detrimental effect on fetal outcomes [17].…”

“…These results are an argument of evaluating the level of immune antibodies or at least checking if the patient was vaccinated against it. In another study, Wang et al [16] assessed the prevalence of measles-mumps-rubella seropositivity according to age in 1015 participants. Rubella seropositivity was only 82.5% in the 20-29-year-old group.…”

Dilemmas and Pitfalls in Rubella Laboratory Diagnostics in Low Prevalence or Elimination Settings

“…It is not possible to distinguish between vaccine-induced and naturally induced [30,31] rubella antibodies and therefore serology testing for rubella within 6-8 weeks after rubella immunization is problematic.…”