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      Increasing Measles Seroprevalence in a Sample of Pediatric and Adolescent Population of Tuscany (Italy): A Vaccination Campaign Success

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          Abstract

          Background: Despite the National Plan for the Elimination of Measles and congenital Rubella (NPEMcR), in 2017, a measles outbreak occurred in Italy, due to sub-optimal vaccination coverage (<95%) for many years. Since that year, the anti-measles vaccination became compulsory in minors (0–16 years) for school attendance. The aim of our study was to assess the immunity/susceptibility against measles in a representative sample of pediatric and adolescent (1–18 years) residents of the province of Florence (Tuscany, Italy), and to compare these results with two previous surveys (2003 and 2005–2006). Methods: The enzyme-linked immunosorbent assay (ELISA) was applied for a qualitative measurement of anti-measles antibodies on 165 sera. The anamnestic and vaccination status was also collected. Results: No measles notification was reported. The overall seropositivity was 88.5%; mostly in the 5–9 years old subjects (97.9%). Among the 152 vaccinated, 92.1% were positive. The seropositivity persisted after many years since the last dose of vaccine and tended to be more long-lasting in those who had received two or three doses. The susceptibility towards measles decreased over time, reaching a lower value in the current survey (8.5%) than in 2003 (30.8%) and in 2005–2006 (25.5%). Conclusions: This study confirmed the anti-measles vaccination campaign success, which allowed for the increase in vaccination coverage and immunity levels against measles in the Florentine pediatric and adolescent population following the NPEMcR implementation.

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          Most cited references40

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          Measles

          Measles is a highly contagious disease that results from infection with measles virus and is still responsible for more than 100 000 deaths every year, down from more than 2 million deaths annually before the introduction and widespread use of measles vaccine. Measles virus is transmitted by the respiratory route and illness begins with fever, cough, coryza, and conjunctivitis followed by a characteristic rash. Complications of measles affect most organ systems, with pneumonia accounting for most measles-associated morbidity and mortality. The management of patients with measles includes provision of vitamin A. Measles is best prevented through vaccination, and the major reductions in measles incidence and mortality have renewed interest in regional elimination and global eradication. However, urgent efforts are needed to increase stagnating global coverage with two doses of measles vaccine through advocacy, education, and the strengthening of routine immunisation systems. Use of combined measles-rubella vaccines provides an opportunity to eliminate rubella and congenital rubella syndrome. Ongoing research efforts, including the development of point-of-care diagnostics and microneedle patches, will facilitate progress towards measles elimination and eradication.
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            Addressing the anti-vaccination movement and the role of HCWs.

            Over the last two decades, growing numbers of parents in the industrialized world are choosing not to have their children vaccinated. Trying to explain why this is occurring, public health commentators refer to the activities of an anti-vaccination movement. The aim of this paper is to review the literature about the anti-vaccination movements and to highlight the knowledge and the skills needed for HCWs to fight against their ideas. The main theoretical structures of anti-vaccination ideology in the 19th and 20th centuries are: vaccines cause idiopathic illness; opponents against vaccines accused vaccine partisans to be afraid of the "search after truth," they fear unveiling errors; the vaccination law not only insults every subject of the realm, but also it insults every human being; vaccine immunity is temporary; an alternative healthy lifestyle, personal hygiene and diet stop diseases. Proponents against vaccination now have additional means to communicate their positions to the general public, the Internet in particular. Doctors and HCWs constantly have to face parents and patients who search information about vaccination. A lot of these people have previously found data about vaccinations from a lot of sources, such as papers, media or in websites and in these sources most contents come from anti-vaccine movements. For these reasons doctors and HCWs need to have updated knowledge about the vaccinations and to know the contents proposed by vaccine sceptics. Educating the general public cannot be fully effective unless there is a corresponding provision, enthusiasm and commitment by trained HCWs.
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              Studies into the mechanism of measles-associated immune suppression during a measles outbreak in the Netherlands

              Measles causes a transient immune suppression, leading to increased susceptibility to opportunistic infections. In experimentally infected non-human primates (NHPs) measles virus (MV) infects and depletes pre-existing memory lymphocytes, causing immune amnesia. A measles outbreak in the Dutch Orthodox Protestant community provided a unique opportunity to study the pathogenesis of measles immune suppression in unvaccinated children. In peripheral blood mononuclear cells (PBMC) of prodromal measles patients, we detected MV-infected memory CD4+ and CD8+ T cells and naive and memory B cells at similar levels as those observed in NHPs. In paired PBMC collected before and after measles we found reduced frequencies of circulating memory B cells and increased frequencies of regulatory T cells and transitional B cells after measles. These data support our immune amnesia hypothesis and offer an explanation for the previously observed long-term effects of measles on host resistance. This study emphasises the importance of maintaining high measles vaccination coverage.
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                Author and article information

                Journal
                Vaccines (Basel)
                Vaccines (Basel)
                vaccines
                Vaccines
                MDPI
                2076-393X
                08 September 2020
                September 2020
                : 8
                : 3
                : 512
                Affiliations
                [1 ]Department of Health Sciences, University of Florence, 50134 Florence, Italy; beatrice.zanella@ 123456unifi.it (B.Z.); sara.boccalini@ 123456unifi.it (S.B.); benedetta.bonito@ 123456unifi.it (B.B.); emilia.tiscione@ 123456unifi.it (E.T.); paolo.bonanni@ 123456unifi.it (P.B.)
                [2 ]Medical Specialization School of Hygiene and Preventive Medicine, University of Florence, 50134 Florence, Italy; marco.delriccio@ 123456unifi.it (M.D.R.); alessandra.ninci@ 123456unifi.it (W.G.D.)
                [3 ]Meyer Children’s Hospital, 50139 Florence, Italy; antonino.sala@ 123456meyer.it
                [4 ]AUSL Toscana Centro, 50122 Florence, Italy; giovanna.mereu@ 123456uslcentro.toscana.it
                Author notes
                [* ]Correspondence: angela.bechini@ 123456unifi.it ; Tel.: +39-055-2751081
                [†]

                Working Group DHS: Jacopo Bianchi, Ilaria Biondi, Martina Chellini, Gino Sartor, Maddalena Innocenti, Federico Manzi, Alessandra Ninci, Diana Paolini.

                [‡]

                Working Group AOUMeyer: Francesco Puggelli, Paola Barbacci, Antonino Sala, Francesca Bellini, Roberto Schiatti, Sonia Muricci.

                [§]

                Working Group AUSLTC: Lorenzo Baggiani, Monica Della Fonte, Giorgio Garofalo, Giovanna Mereu, Simonetta Baretti, Maria Grazia Santini.

                Author information
                https://orcid.org/0000-0001-6718-1932
                https://orcid.org/0000-0002-9695-7549
                https://orcid.org/0000-0002-2742-0297
                https://orcid.org/0000-0003-2875-3744
                https://orcid.org/0000-0002-6013-8779
                Article
                vaccines-08-00512
                10.3390/vaccines8030512
                7565840
                32911762
                7d13911c-f8cc-41cd-95ff-d2d5c7c86917
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 30 July 2020
                : 04 September 2020
                Categories
                Article

                measles,elimination,vaccination,pediatric,adolescence,seroprevalence,italy,vaccination coverage,vaccination effectiveness,mmrv vaccination

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