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Measles 2025

Author/s: 
Lien Anh Ha Do, Kim Mulholland

Measles is a highly contagious virus with a primary case reproduction number (i.e., the average number of secondary cases per case patient) of 12 to 18. It is currently spreading rapidly owing to reduced measles vaccination coverage, which is due primarily to the disruption of local immunization programs by the coronavirus disease 2019 (Covid-19) pandemic and of growing vaccine hesitancy.1 Since 2024, all World Health Organization (WHO) regions have reported increased numbers of measles cases, with 395,521 laboratory-confirmed measles cases reported in 2024 and 16,147 reported during the first 2 months of 2025.2 Patients in more than half the reported cases were hospitalized, so the true number is probably much higher.3
This review covers clinical presentations and complications of measles, current recommendations, and the epidemiologic background of measles. It also addresses the current debates on immunization and the treatment of measles and presents information on the origins of the various measles vaccines and updates on measles diagnostic testing and molecular genotypes.

Keywords 
measles vaccines Epidemiology

Human Papillomavirus Immunization in Rural Primary Care

Author/s: 
Ferrara, Laura, K., Gunn, Rose, Dickinson, Caitlin, Stock, Isabel, Griffith-Weprin, Jennifer, Wiser, Amy, Hatch, Brigit, Fagnan, L.J., Carney, P.A., Davis, M.M.

Abstract

Introduction: Despite the safety and efficacy of the human papillomavirus vaccine, thousands are impacted by human papillomavirus and its related cancers. Rural regions have disproportionately low rates of human papillomavirus vaccination. Primary care clinics play an important role in delivering the human papillomavirus vaccine. A positive deviance approach is used to identify workflows, organizational factors, and communication strategies in rural clinics with higher human papillomavirus vaccine up-to-date rates. Positive deviance is a process by which exceptional behaviors and strategies are identified to understand factors that enable success.

Methods: Rural primary care clinics were rank ordered by human papillomavirus vaccine up-to-date rates using 2018 Oregon Immunization Program data, then recruited via purposive sampling of clinics in the top and bottom quartiles. Two study team members conducted previsit interviews, intake surveys, and 2-day observation visits with 12 clinics and prepared detailed field notes. Data were collected October-December 2018 and analyzed using a thematic approach January-April 2019.

Results: Four themes distinguished rural clinics with higher human papillomavirus vaccine up-to-date rates from those with lower rates. First, they implemented standardized workflows to identify patients due for the vaccine and had vaccine administration protocols. Second, they designated and supported a vaccine champion. Third, clinical staff in higher performing sites were comfortable providing immunizations regardless of visit type. Finally, they used clear, persuasive language to recommend or educate parents and patients about the vaccine's importance.

Conclusions: Positive deviance identified characteristics associated with higher human papillomavirus vaccine up-to-date rates in rural primary care clinics. These findings provide guidance for rural clinics to inform human papillomavirus vaccination quality improvement interventions.

Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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