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Measles, mumps and rubella are viral infectious diseases that may cause severe and devastating complications among affected individuals. The disease burden of all three diseases is high, but could be reduced entirely through successful vaccination strategies. As such, the WHO has established the goal of globally eliminating measles and rubella and concomitantly controlling the frequently co-vaccinated mumps.
In 2010, the WHO European Region member states agreed to strengthen efforts to eliminate measles and rubella from Europe by the end of 2015. As this date draws closer, progress analyses become increasingly relevant. In this systematic literature review, the immunization strategies, vaccination coverages and disease incidences of eleven European nations were assessed and their progress towards disease elimination evaluated.
Successful prevention of the endemic transmission of measles, mumps, or rubella could be achieved in several nations, including Sweden, Croatia, Greece and Spain. Austria, France, Germany, Italy, Poland, Turkey and the United Kingdom of Great Britain and Northern Ireland, though having improved their overall immunization rates, have not yet been able to reach the elimination goals. In Turkey, Italy and Poland, sharp increases in case numbers during recent years are potentially threatening the successful measles, mumps and rubella control in Europe.
Pockets of susceptible population groups that may contribute to the perpetuation of the diseases have been identified. They include infants and young children, adolescents and young adults, adolescent and adult males, recent immigrants and refugees,and traveling ethnic minority groups. Reasons for the increased risk of infection among these groups are manifold and a result of various historic and current vaccination practices, cultural, political and religious differences, as well as individual believes and concerns. Travel and migration of infected individuals to and between the various European nations also play an essential role in the continual transmission of measles, mumps and rubella in Europe. Only an adequate population-wide immunity can prevent the occurrence of major outbreaks due to viral importation. Efforts should therefore be made to immunize all population members able to receive vaccinations and to offer additional immunization opportunities to those susceptible population subgroups that are difficult to reach through routine vaccination programs.
In countries struggling to meet the WHO elimination goals, alternative immunization practices may be necessary. A uniform, European-wide MMR vaccination schedule based on the successful immunization methods of countries that have eliminated measles, mumps and rubella may be an effective tool for improving the overall population-wide immunity and controlling the three diseases. A model for such a schedule was created and includes strategies for reaching population members regardless of age, gender or migratory background. The implementation of uniform immunization recommendations is challenging, but the advantages in terms of improved vaccination, surveillance and disease control methods may be worth at least considering such a strategy in Europe.
Measles, mumps and rubella elimination may be attainable in the WHO European Region. The current epidemiological situation suggests that the goal is unlikely to be reached by the end of 2015, but through continued international efforts and collaboration, effective disease control could be achieved in the near future. In the meantime, improvements in immunization strategies, vaccination coverages, supplementary campaigns as well as disease notification systems and confirmations should be made on a national and international level, so that an adequate population-wide immunity can be established and the disease elimination progresses effectively monitored within the entire European region.
Investigations of Measles virus regulation on activation and function of antigen presenting cells
(2008)
Interaction with dendritic cells (DCs) is considered as central to immunosuppression induced by viruses, including measles virus (MV). Commonly, viral infection of DCs abrogates their ability to promote T cell expansion, yet underlying mechanisms at a cellular level are undefined. It appears that MV-WTF infection modulate DCs morphology and dynamic adhesion on extra cellular matrix proteins such as FN or ICAM-1. By morphological criteria, WTF-DCs resembled LPS-DCs, associated with their mature phenotype also adhered less efficiently to the FN or ICAM-1 support. Reduced adhesion could not be explained by a lack of 1-integrin expression or activation. Similarly, MV-DCs strongly resembled LPS-DCs in that levels of focal adhesion kinase phosphorylated at Y397 were high and not further enhanced upon FN ligation. Fascin, a downstream effector of integrin signaling was highly upregulated in LPS-DCs and moderately in WTF-DCs, and differences in its subcellular distribution were not observed between both cell cultures. Apparently, however, fascin associated less efficiently with PKC in WTF-DCs then in LPS-DCs. In line with findings for murine DCs, high motility of mature human DCs was found to require expression of Rac-GTPases. Human LPS-DCs and more so, DC transfected to express constitutively active Rac1 were the most motile DC-species analysed, confirming that migration of human DC also involved Rac activity. The velocity of WTF-DCs on FN is below that of LPS-DCs, indicating that maturation induced by WTF may be insufficient to completely promote integrin signaling which leads to Rac activation. The organisation of MV-DC/T cell interfaces was consistent with that of functional immune synapses with regard to CD3 clustering, MHC class II surface recruitment and MTOC location. These analyses are based in the selection of stable conjugates. Subsequently, however, neither contacts nor calcium flux can be stabilised and sustained in the majority of MV-DC/T cell conjugates and only promoted abortive T cell activation. Formation of spatially organised IS in T cells requites, prolonged contact durations. Therefore, aberrant distribution patterns of CD3 in these structures, if occurring, are not likely to contribute to the type of contacts predominating for WTF-DC/T cell interactions. It is also likely that transient interactions of less than 2 minutes may if at all, not efficiently support viral transmission to T cells. Transient interactions are typically observed with immature DCs in the absence of antigen, but this is not likely to be relevant in our allogenic system, which includes SA-loaded WTF-DCs. Thus, MV-infected DCs retain activities required for initiating, but not sustaining T cell conjugation and activation. This is partially rescued if surface expression of the MV glycoproteins on DCs is abolished by infection with a recombinant MV encoding VSV G protein instead, indicating that these contribute directly to synapse destabilisation and thereby act as effectors of T cell inhibition.