Measles elimination: a mass immunization campaign in Romania

Ion-Nedelcu, N; Crăciun, D; Pițigoi, Daniela; Popa, Mircea Ioan; Hennessey, Karen; Roure, C.; Aston, Robert Lee; Zimmermann, G.; Pelly, Michael; Strebel, Peter M.

doi:10.2105/ajph.91.7.1042

Cited by 11 publications

(4 citation statements)

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“…That campaign left consequences that have effects even today. When comparing the current situation with the 1998–1999 period, when we organized the largest nationwide vaccination campaign, vaccinating about 2.1 million people without serious side effects and without refusals to vaccinate, the problems related to accepting vaccination are significant [ 19 ]. The phenomenon of vaccine refusal has emerged as a serious social movement and is spreading worldwide [ 20 , 21 , 22 , 23 , 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Attitudes on Vaccination in Southern Romanians: A Cross-Sectional Questionnaire

Popa

Muntean

et al. 2020

Vaccines

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Vaccines are fundamental instruments upon which all modern medicine is hinged. This has recently come into the light because of the COVID-19 pandemic caused by SARS-CoV-2. We aimed to assess the knowledge and attitudes of the public regarding vaccination. To this end, a questionnaire, which was disseminated to the general population between 2017 and 2019, was used. We evaluated the responses from 1647 individuals (61% female, with a median age of 37 years, mostly from urban settings). Most respondents (85%) had children and were in favor of vaccination. Our study underlines the role that family physicians have in the education and information of citizens. A small, but considerable, number of respondents (108, 7.84% of those with children) had not vaccinated their children according to the national vaccination scheme. Deterrents were considered to be lack of information and fear of side effects. However, 167 of our respondents (12.12% out of 1377 respondents with children) said that their child experienced adverse events—most of which were mild local reactions. Alternatives to vaccination were proposed by some. In this study, we highlight the attitudes of respondents and multiple gaps in general knowledge, both of which may need to be addressed, especially in light of the current pandemic situation and past failed campaigns.

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Section: Discussionmentioning

confidence: 99%

Knowledge and Attitudes on Vaccination in Southern Romanians: A Cross-Sectional Questionnaire

Popa

Muntean

et al. 2020

Vaccines

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“… 107 In response, Romania implemented enhanced surveillance and a nationwide immunization campaign, vaccinating 2.1 million 7–18 year-olds. 107 , 108 MMR vaccination was introduced in 2004, with MCV1 given at 12–15 months and MCV2 initially given at 6–7 years of age (and at 5 years of age since 2015). 106 …”

Section: Resultsmentioning

confidence: 99%

Evolving measles status and immunization policy development in six European countries

Vojtek

Larson

Plotkin

et al. 2022

Human Vaccines & Immunotherapeutics

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Developing and implementing new immunization policies in response to shifting epidemiology is a critical public health component. We adopted a mixed-methods approach (via narrative literature review [101 articles] and 9 semi-structured interviews) to evaluate policy development in response to shifting measles epidemiology in six European countries (Italy, Belgium, Germany, Romania, UK, and Ukraine); where policies and strategies have evolved in response to country-specific disease and vaccination patterns. Periodic outbreaks have occurred in all countries against a background of declining measles-containing-vaccine (MCV) uptake and increasing public vaccine hesitancy (with substantial regional or social differences in measles burden and vaccine uptake). Health-care worker (HCW) vaccine skepticism is also seen. While many outbreaks arise or involve specific susceptible populations (e.g., minority/migrant communities), the broader pattern is spread to the wider (and generally older) population; often among incompletely/non-vaccinated individuals as a legacy of previous low uptake. Immunization policy and strategic responses are influenced by political and social factors, where public mistrust contributes to vaccine hesitancy. A strong centralized immunization framework (allied with effective regional implementation and coherent political commitment) can effectively increase uptake. Mandatory vaccination has increased childhood MCV uptake in Italy, and similar benefits could be anticipated for other countries considering vaccine mandates. Although possible elsewhere, socio-political considerations render mandating impractical in other countries, where targeted immunization activities to bolster routine uptake are more important. Addressing HCW skepticism, knowledge gaps, improving access and increasing public/community engagement and education to address vaccine hesitancy/mistrust (especially in communities with specific unmet needs) is critical.

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“…A proven and extremely cost-effective way of rapidly controlling measles in countries with poor routine immunization coverage is a measles immunization campaign. 3 , 4 , 5 , 6 Ignoring this evidence the paper concludes that “our data showed the limited outcomes of mass vaccination campaign.”…”

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confidence: 82%

Letters to the Editor

Kuroiwa

2002

Journal of Epidemiology

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In a recent article (J Epidemiol 2001; 11: 255-262) , flawed analysis of limited data led to an incorrect conclusion that a measles immunization campaign in the Lao People's Democratic Republic had minimal impact. The article also inaccurately portrays WHO policy.On October 29, 2000, the Western Pacific Region was certified as polio-free.' Laos' historic achievement in eliminating polio was questioned at that time by the same authors .2 But, Laos remains polio-free.Despite the cynics and the nay-sayers, global smallpox eradication and regional polio elimination were achieved. The paper rightly points out that measles eradication will be even harder and that measles control efforts must not interfere with polio eradication. However, that is not the issue for Laos, where polio has been eliminated and a high standard of acute flaccid paralysis surveillance is being maintained.A proven and extremely cost-effective way of rapidly controlling measles in countries with poor routine immunization coverage is a measles immunization campaign.3.4.5.6 Ignoring this evidence the paper concludes that "our data showed the limited outcomes of mass vaccination campaign."The conclusion is based on an estimate of vaccine efficacy (VE) in a small number of outbreaks before the campaign. Outbreaks, by their nature, lead to lower VE estimates.' The VE estimate of 68% is used to arbitrarily guess that protection after a second dose would only be 80% effective. In fact, two doses of measles vaccine are about 99% effective.8.9 The article uses the VE estimates multiplied by estimated coverage to compare percentage immunity with and without a campaign. The difference in immunity is then multiplied by the percent of cases vaccinated to estimate the percent reduction in measles from the campaign.This calculation not only fails to appreciate the indirect effect of immunization ('herd immunity') but also that the proportion of cases who are immunized increases with immunization coverage.The article then further minimizes the estimate of impact of the campaign by multiplying the percent reduction to a total number of reported cases for a year during which there were relatively few cases. There is no consideration that most measles cases are not even reported.In addition to the flaws in logic and mathematics, the VE estimate deserves further scrutiny. Simply providing a statistical confidence interval to the point estimate shows that there is a 95% chance that the VE could be up to 79%. More important than the play of chance are the biases of the screening method. To start with, there is always uncertainty about the true immunization status of the cases, and the investigators do not state whether they accepted a history without written documentation. A sub-analysis for cases with vaccination cards is likely to show higher VE.

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Measles elimination: a mass immunization campaign in Romania

Cited by 11 publications

References 1 publication

Knowledge and Attitudes on Vaccination in Southern Romanians: A Cross-Sectional Questionnaire

Knowledge and Attitudes on Vaccination in Southern Romanians: A Cross-Sectional Questionnaire

Evolving measles status and immunization policy development in six European countries

Letters to the Editor

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