Objective: To analyze the direct economic burden caused by measles cases in Shanghai from 2017 to 2019 and its influencing factors. Methods: A total of 161 laboratory-confirmed measles cases reported from January 1, 2017, to December 31, 2019, in Shanghai were included in the study through the "Measles Surveillance Information Reporting and Management System" of the "China Disease Surveillance Information Reporting and Management System". Through telephone follow-up and consulting hospital data, the basic information of population, medical treatment situation, medical treatment costs and other information were collected, and the direct economic burden of cases was calculated, including registration fees, examination fees, hospitalization fees, medical fees and other disease treatment expenses, as well as transportation and other expenses of cases. The multiple linear regression model was used to analyze the main influencing factors of the direct economic burden. Results: The age of 161 measles cases M (Q₁, Q₃) was 28.21 (13.33, 37.00) years. Male cases (56.52%) were more than female cases (43.48%). The largest number of cases was≥18 years old (70.81%). The total direct economic burden of 161 measles cases was 540 851.14 yuan, and the per capita direct economic burden was 3 359.32 yuan. The direct economic burden M (Q₁, Q₃) was 873.00 (245.01, 4 014.79) yuan per person. The results of multiple linear regression model analysis showed that compared with other and unknown occupations, central areas and non-hospitalized cases, the direct economic burden of measles cases was higher in scattered children, childcare children, students, and cadre staff in the occupational distribution, suburban areas and hospitalized, with the coefficient of β (95%CI) values of 0.388 (0.150-0.627), 0.297 (0.025-0.569), 0.327 (0.148-0.506) and 1.031 (0.853-1.209), respectively (all P values<0.05). Conclusion: The direct economic burden of some measles cases in Shanghai is relatively high. Occupation, area of residence and hospitalization are the main factors influencing the direct economic burden of measles cases.
Child ; Humans ; Male ; Female ; Adolescent ; Financial Stress ; Cost of Illness ; China/epidemiology* ; Health Care Costs ; Measles/epidemiology*

Background. Subacute sclerosing panencephalitis (SSPE) is a fatal neurodegenerative disease caused by prolonged persistent infection of the central nervous system with a measles virus mutant. Though various treatment modalities have been tried, there is no effective treatment to completely cure SSPE and new therapeutic strategies are needed.

Objective. This is a prospective uncontrolled observational open label trial to describe the short-term outcomes and safety of intraventricular ribavirin in combination with oral isoprinosine in Filipino SSPE patients.

Methods. Sixteen (16) unrelated SSPE patients between ages 3-26 years and in various clinical stages were included in this study. Demographic data were described. Intraventricular instillation of ribavirin (1-3 mg/kg/dose) through an Ommaya reservoir was given for a duration of 3-6 months in 13 patients. The duration of follow-up was 48 weeks. The clinical outcome was assessed before, during, and after treatment using the Neurological Disability Index (NDI), Brief Assessment Examination (BAE), and clinical staging using the Jabbour Classification. Adverse side effects from intraventricular ribavirin were enumerated.

Results. Six of 13 (46.15%) patients mostly in Stage III illness had clinical improvement showing decreasing NDI and BAE scores during treatment and the clinical improvement was maintained or improved further during the 48-week follow-up period. Clinical improvement manifested as improved mental alertness, decrease in spasticity and reduction of seizures. The clinical staging of those who improved remained stable during and after treatment was discontinued. Five (38.46%) patients in Stage II disease worsened and progressed to Stage III despite ribavirin therapy including 1 (7.6%) patient who died after the treatment phase due to pneumonia and brainstem failure. The clinical course of two (15.38%) patients remained unchanged. Minor adverse side effects of ribavirin included transient fever, rash, oral sores, seizure episodes, drowsiness, bladder retention and mild increase in transaminases. Ommaya reservoir infection was a serious adverse event in 5 (31.25%) patients.

Conclusion. There is still no definitive cure for SSPE. Although ribavirin may help alleviate some of the symptoms of SSPE and prolong life, it may not reverse or halt the progression of the disease. Long term follow-up of these patients and continuous use of intraventricular ribavirin will better clarify its role in modifying the fatal course of SSPE. The role of ribavirin in Stage I patients and a controlled clinical trial in Stage II SSPE needs further studies.

Background: Measles surged worldwide in 2019, which recorded the highest number of cases in the last 23 years. In the Philippines, the peak of the outbreak occurred in January-February 2019.1-3 Pneumonia was the most common severe complication and cause of death of measles. Age, sex, area of residence, immunization history, nutrition status and presence of comorbidities may contribute to the development of high-risk pneumonia in measles patients, affecting clinical outcomes. Objective: This study aimed to determine predictive factors for high-risk pneumonia among hospitalized pediatric patients with measles and clinical outcomes in San Lazaro Hospital from January 2019 to December 2019. Methods: A cohort study was conducted through a review of medical records of pediatric patients with measles admitted at San Lazaro Hospital from January 2019 to December 2019. The following data were extracted: demographic data, immunization history, nutrition status, presence of comorbidities, development of high-risk pneumonia, and clinical outcomes were extracted. Logistic regression was done to determine the factors associated with development of high-risk pneumonia. Results: A total of 530 medical records were reviewed, and 27.9% of these documented severe pneumonia. Most of the patients were less than 5 years of age (84.53%) and were residing in Metro Manila (85.47%). Majority (73.40%) had no vaccination for measles. Chi-square test showed that the variables of age (p=0.001), measles vaccination status (p=0.011), BMI-for-age (p=0.005), weight-for-age (p=0.027), and weight-for-height (p=0.004) were significantly different between those who developed high-risk pneumonia and those who did not. However, in the final multiple logistic regression analysis, only nutritional status was predictive of high-risk pneumonia. Patients with severe wasting were 1.85 times (p=0.010) and patients who were overweight were 4.24 times (p=0.003) more likely to develop high-risk pneumonia. There was also a significant difference in clinical outcomes between those without high-risk and with high-risk pneumonia (p=<0.001). All mortality cases had high-risk pneumonia, were less than 5 years of age, and were unvaccinated. Conclusion Age, measles vaccination status and nutrition status were the factors identified to be associated with high-risk pneumonia among pediatric patients with measles. Thus, it is important to encourage parents to vaccinate their children against measles and to promote proper nutrition.
Pneumonia ; Measles

Objective: To determine IgG antibody levels of measles, rubella, mumps in healthy population in Shanghai from 2010 to 2020 and analyze the trend of antibody changes in different age groups. Methods: 10 828 healthy people without measles, rubella and mumps in Shanghai were included in the study from 2010 to 2020. Serum samples were collected from 12 age groups, and the serum IgG antibody of measles, rubella and mumps were detected by ELISA. The difference of antibody positive rates and antibody levels were analyzed. Results: The median age M (Q₁, Q₃) of 10 828 objects were 8 years old (9 months old, 20 years old). Males accounted for 48.34% (5 234/10 828) and females accounted for 50.92% (5 514/10 828). Unknown gender information accounted for 0.74% (80/10 828), and 27.03% (2 927/10 828) of participants had unknown MMR immunization history. The total positive rates of measles, rubella and mumps IgG antibody were 76.78%, 64.46% and 64.29% and their GMCs were 541.45 mIU/ml, 31.76 IU/ml and 133.73 U/ml respectively. There were significant differences in serum IgG antibody GMC of measles, rubella and mumps in each year (F_measles=180.74, P<0.001; F_rubella=189.95, P<0.001; F_mumps=122.40, P<0.001). The positive rate of measles antibody was higher than that of rubella and mumps, and the difference was statistically significant (χ²=518.09, P<0.001). Conclusion: The level of measles IgG antibody in healthy people in Shanghai is higher, while the level of rubella and mumps IgG antibody is slightly lower.
Adult ; Antibodies, Viral ; Child ; China/epidemiology* ; Female ; Humans ; Immunoglobulin G ; Infant ; Male ; Measles/prevention & control* ; Measles-Mumps-Rubella Vaccine ; Mumps/prevention & control* ; Mumps virus ; Rubella/prevention & control* ; Young Adult

HPV vaccination is the most effective way for preventing the cervical cancer. To respond the WHO calling for cervical cancer elimination, some Chinese provincial governments are launching the Free HPV Vaccination Programs for teenagers. Basing on the current stage of domestic utilization and the global immunization strategies of HPV vaccination, this paper provides a comprehensive review of the key aspects in the process of HPV vaccination, including subjects and priority vaccination population, vaccination dose and time interval, the principal of vaccination replacement, and the vaccination suggestion on special populations, etc. The article above contents and gives the advice on the immunization strategy of HPV vaccination in China.
AIDS Vaccines ; Adolescent ; BCG Vaccine ; China ; Diphtheria-Tetanus-Pertussis Vaccine ; Female ; Humans ; Immunization Programs ; Influenza Vaccines ; Measles-Mumps-Rubella Vaccine ; Papillomavirus Infections/prevention & control* ; Papillomavirus Vaccines ; Respiratory Syncytial Virus Vaccines ; SAIDS Vaccines ; Uterine Cervical Neoplasms ; Vaccination

Adult ; Aged ; Antibodies, Viral/metabolism* ; China ; Female ; Humans ; Immunoglobulin G/metabolism* ; Male ; Measles/metabolism* ; Measles virus/physiology* ; Medical Staff ; Middle Aged ; Saliva/virology* ; Young Adult

Infectious diseases are caused by infection of organism with pathogenic agents, which may lead to epidemics. Many infectious diseases such as syphilis, diphtheria, measles, and acquired immunodeficiency syndrome have specific and non-specific manifestations in the oral cavity. However, the same disease may have different oral manifestations in different patients clinically. We can apply the strategy of "three unusuals and one change" in clinical reasoning for diagnosis of infectious diseases with oral manifestations. The so-called "three unusuals" refer to unusual age, unusual location and unusual effect, and "one change" means the change from rare to common. In this article, we will give a comprehensive introduction about the oral manifestations of common communicable diseases and their diagnostic strategies.
Acquired Immunodeficiency Syndrome ; Humans ; Measles ; Syphilis

Delivery of Health Care ; Health Personnel ; Humans ; Korea ; Measles-Mumps-Rubella Vaccine ; Mumps ; Republic of Korea ; Seroepidemiologic Studies ; Tertiary Healthcare ; Vaccination

An increase in the number of patients with infectious diseases in Korea, can be attributed to various factors, such as the prevalence of new infectious diseases of the 21st century, the re-emergence of past infectious diseases, an increase in the number of elderly individuals, patients with chronic diseases, immune deficiency, and globalization. In this context, vaccination becomes vital for the adult population. Although, the guidelines for adult immunization are currently being updated, the rate of adult vaccination remains lower than that of infant vaccination. At present, the major challenges for increasing the rate of adult immunization include negative views on the need for some immunizations and a lack of understanding of group immunity among the youth. Consequently, a successful immunization program will be required to direct efforts towards educating patients and spreading awareness. Based on the current guidelines and practical applications, varicella zoster; Japanese encephalitis; tetanus, diphtheria, and pertussis; pneumococcus; measles, mumps, and rubella; and hepatitis A vaccines could effectively be considered for adult vaccination.
Adolescent ; Adult ; Aged ; Chickenpox ; Chronic Disease ; Communicable Diseases ; Diphtheria ; Encephalitis, Japanese ; Hepatitis A Vaccines ; Herpes Zoster ; Humans ; Immunization Programs ; Immunization ; Infant ; Internationality ; Korea ; Measles ; Mumps ; Pneumococcal Vaccines ; Prevalence ; Rubella ; Streptococcus pneumoniae ; Tetanus ; Vaccination ; Whooping Cough

BACKGROUND: Warts, caused by the human papilloma virus (HPV), are mucocutaneous proliferations controlled by cell-mediated immunity. Intralesional immunotherapy with measles, mumps, and rubella (MMR) vaccine, is postulated to induce a higher immune response for clearance of lesions.
OBJECTIVE: To assess the efficacy, safety and effect on recurrence of intralesional MMR vaccine for the treatment of warts.
METHODS: We searched online databases for randomized controlled trials on intralesional MMR vaccine for warts. Effects measured were the complete clearance of target and distant warts, adverse events noted and recurrence after treatment duration.
RESULTS: Four RCTs comparing intralesional MMR vaccine and placebo were assessed. Meta-analysis showed a risk ratio of 0.24 [95% CI: 0.18, 0.34] favoring intralesional MMR vaccine and a highly significant difference in completely clearing target warts (P-value <0.00001) versus placebo. Three of the 4 trials assessed response of distant warts showing a risk ratio of 0.28 [95% CI: 0.08, 0.96] and a significant difference (P=0.04) versus placebo. Pain and flu-like symptoms were the most common side effects with no recurrence seen after 3-6 months.
CONCLUSIONS: Intralesional MMR vaccine significantly reduces and clears target and distant warts as compared to placebo. It is a generally safe intervention with lasting effect assessed up to 6 months follow-up.