Emily P. Hyle, MD, MSc; Sowmya R. Rao, PhD; Emily S. Jentes, PhD, MPH; Amy Parker Fiebelkorn, MSN, MPH; Stefan H.F. Hagmann, MD, MSc; Allison Taylor Walker, PhD, MPH; Rochelle P. Walensky, MD, MPH; Edward T. Ryan, MD; Regina C. LaRocque, MD, MPH
Disclaimer: The content is solely the responsibility of the authors, and the study's findings and conclusions do not necessarily represent the official position of the National Institutes of Health or CDC.
Acknowledgment: The authors thank Mr. Ethan Borre for his assistance with manuscript preparation. Members of the Global TravEpiNet Consortium (in alphabetical order) are George M. Abraham, Saint Vincent Hospital (Worcester, Massachusetts); Salvador Alvarez, Mayo Clinic (Jacksonville, Florida); Vernon Ansdell and Johnnie A. Yates, Travel Medicine Clinic, Kaiser Permanente (Honolulu, Hawaii); Elisha H. Atkins, Chelsea HealthCare Center (Chelsea, Massachusetts); Holly K. Birich and Dagmar Vitek, Salt Lake Valley Health Department (Salt Lake City, Utah); John Cahill, Travel and Immunization Center, St. Luke's-Roosevelt (New York, New York); Lin Chen, Mount Auburn Hospital (Cambridge, Massachusetts); Bradley A. Connor, New York Center for Travel and Tropical Medicine, Cornell University (New York, New York); Roberta Dismukes, Jessica Fairley, Phyllis Kozarsky, and Henry Wu, Emory TravelWell, Emory University (Atlanta, Georgia); Ronke Dosunmu, JourneyHealth (Maywood, New Jersey); Jeffrey A. Goad and Edith Mirzaian, International Travel Medicine Clinic, University of Southern California (Los Angeles, California); Brian Kendall, Daniel Leung, and DeVon Hale, International Travel Clinic, University of Utah (Salt Lake City, Utah); Noreen A. Hynes, Johns Hopkins Travel and Tropical Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine (Baltimore, Maryland); Frederique Jacquerioz and Susan McLellan, Tulane University (New Orleans, Louisiana); Mark Knouse, Keystone Travel Medicine, Lehigh Valley Health Network (Allentown, Pennsylvania); Jennifer Lee, Northwestern Medical Group-Travel Medicine, Northwestern Memorial Hospital (Chicago, Illinois); Alawode Oladele and Hanna Demeke, DeKalb County Board of Health Travel Services-DeKalb North and Central-T.O. Vinson Centers (Decatur, Georgia); Alawode Oladele and Althea Otuata, DeKalb County Board of Health Travel Services-DeKalb East (Decatur, Georgia); Roger Pasinski and Amy E. Wheeler, Revere HealthCare Center (Revere, Massachusetts); Jessica Rosen and Laura Coster, Infectious Diseases and Travel Medicine, Georgetown University (Washington, DC); Brian S. Schwartz, Travel Medicine and Immunization Clinic, University of California, San Francisco (San Francisco, California); William Stauffer and Patricia Walker, HealthPartners Travel Medicine Clinics (St. Paul, Minnesota); and Joseph Vinetz, Travel Clinic, Division of Infectious Diseases, Department of Medicine, University of California-San Diego School of Medicine (La Jolla, California).
Grant Support: This work was supported by CDC grants U19CI000514 and U01CK000175, by the National Institutes of Health (K01 HL123349) (Dr. Hyle), and by the Steve and Deborah Gorlin MGH Research Scholars Award (Dr. Walensky).
Disclosures: Dr. Hyle reports grants from the National Institutes of Health and Centers for Disease Control and Prevention during the conduct of the study. Dr. Walensky reports grants from National Institutes of Health during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2249.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Not available. Statistical code: Available from Dr. Rao (e-mail, firstname.lastname@example.org). Data set: Available from Dr. LaRocque (e-mail, email@example.com).
Requests for Single Reprints: Emily P. Hyle, MD, MSc, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Hyle: Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.
Dr. Rao: Massachusetts General Hospital Biostatistics Center, 50 Staniford St, 5th Floor, Boston, MA 02114.
Drs. Jentes and Taylor Walker: Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E 03, Atlanta, GA 30333.
Ms. Parker Fiebelkorn: Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-34, Atlanta, GA 30333.
Dr. Hagmann: Division of Pediatric Infectious Diseases, Bronx-Lebanon Hospital Center, 1650 Selwyn Avenue, Bronx, NY 10457.
Dr. Walensky: Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.
Drs. Ryan and LaRocque: Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Jackson 504, Boston, MA 02114.
Author Contributions: Conception and design: E.P. Hyle, A. Parker Fiebelkorn, S.H.F. Hagmann, A. Taylor Walker, E.T. Ryan, R.C. LaRocque.
Analysis and interpretation of the data: E.P. Hyle, S.R. Rao, E.S. Jentes, A. Parker Fiebelkorn, S.H.F. Hagmann, E.T. Ryan, R.C. LaRocque.
Drafting of the article: E.P. Hyle, A. Parker Fiebelkorn, S.H.F. Hagmann, E.T. Ryan, R.C. LaRocque.
Critical revision of the article for important intellectual content: E.P. Hyle, S.R. Rao, E.S. Jentes, A. Parker Fiebelkorn, S.H.F. Hagmann, A. Taylor Walker, R.P. Walensky, E.T. Ryan, R.C. LaRocque.
Final approval of the article: E.P. Hyle, S.R. Rao, E.S. Jentes, A. Parker Fiebelkorn, S.H.F. Hagmann, A. Taylor Walker, R.P. Walensky, E.T. Ryan, R.C. LaRocque.
Provision of study materials or patients: E.T. Ryan.
Statistical expertise: S.R. Rao, E.S. Jentes, A. Taylor Walker, E.T. Ryan.
Obtaining of funding: E.T. Ryan, R.C. LaRocque.
Administrative, technical, or logistic support: E.T. Ryan.
Collection and assembly of data: E.P. Hyle, S.H.F. Hagmann, E.T. Ryan, R.C. LaRocque.
Measles outbreaks continue to occur in the United States and are mostly due to infections in returning travelers.
To describe how providers assessed the measles immunity status of departing U.S. adult travelers seeking pretravel consultation and to assess reasons given for nonvaccination among those considered eligible to receive the measles, mumps, rubella (MMR) vaccine.
Observational study in U.S. pretravel clinics.
24 sites associated with Global TravEpiNet (GTEN), a Centers for Disease Control and Prevention–funded consortium.
Adults (born in or after 1957) attending pretravel consultations at GTEN sites (2009 to 2014).
Structured questionnaire completed by traveler and provider during pretravel consultation.
40 810 adult travelers were included; providers considered 6612 (16%) to be eligible for MMR vaccine at the time of pretravel consultation. Of the MMR-eligible, 3477 (53%) were not vaccinated at the visit; of these, 1689 (48%) were not vaccinated because of traveler refusal, 966 (28%) because of provider decision, and 822 (24%) because of health systems barriers. Most MMR-eligible travelers who were not vaccinated were evaluated in the South (2262 travelers [65%]) or at nonacademic centers (1777 travelers [51%]). Nonvaccination due to traveler refusal was most frequent in the South (1432 travelers [63%]) and in nonacademic centers (1178 travelers [66%]).
These estimates could underrepresent the opportunities for MMR vaccination because providers accepted verbal histories of disease and vaccination as evidence of immunity.
Of U.S. adult travelers who presented for pretravel consultation at GTEN sites, 16% met criteria for MMR vaccination according to the provider's assessment, but fewer than half of these travelers were vaccinated. An increase in MMR vaccination of eligible U.S. adult travelers could reduce the likelihood of importation and transmission of measles virus.
Centers for Disease Control and Prevention, National Institutes of Health, and the Steve and Deborah Gorlin MGH Research Scholars Award.
Assessment of adult travelers' measles immunity and action regarding MMR vaccination by providers at 24 GTEN sites (2009 to 2014).
GTEN = Global TravEpiNet; MMR = measles, mumps, rubella; PCP = primary care provider.
* At least 1 specific reason supporting measles immunity was documented for 28 107 (82%) of these travelers (that is, a history of 2 MMR vaccinations, known positive result on serologic testing, or self-reported history of illness). Providers could select more than 1 supporting reason: 1017 (4%) travelers had 2 MMR vaccinations and a positive serologic result, 220 (0.8%) travelers had 2 MMR vaccinations and self-reported history of illness, and 53 (0.2%) travelers had a positive serologic result and self-reported history of illness.
† Of the 24 884 travelers for whom providers noted 2 prior doses of MMR vaccine, providers noted specific supporting evidence (for example, a date) for previous vaccinations in 11 326 (46%).
‡ Between 2009 and 2012, providers did not have to specify reason for traveler refusal.
§Between 2012 and 2014, providers had to select 1 of 3 reasons for traveler refusal.
Appendix Table 1. GTEN Clinical Sites and Number of Travelers Who Provided Data per Year of the Study
Table 1. Demographic and Travel-Related Characteristics of Adult Travelers Evaluated at GTEN Clinics (2009 to 2014)*
Table 2. Demographic and Travel-Related Characteristics of Adult MMR-Eligible Travelers Who Were Vaccinated and Not Vaccinated With This Vaccine*
Table 3. Action Regarding MMR Vaccinations Among Eligible Adult Travelers, by Geographic Region of Global TravEpiNet*
Appendix Table 2. Demographic and Travel-Related Characteristics of Adult Travelers Evaluated at GTEN Clinics in 4 U.S. Regions (2009 to 2014)
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June 4, 2019
"missed opportunity" for inducing type 1 diabetes
It is also a "missed opportunity" for inducing type 1 diabetes in them. So that is a public health gain.
In the ~40 year history of the measles, mumps, rubella (MMR) vaccine, with no safety improvements, I was the first to point out the mechanism by which this GAD65 protein contaminated chick embryo cell culture derived vaccine causes the development of type 1 diabetes (T1D).
Role of MMRII vaccine contamination with GAD65 containing chick embryo cell culture in the etiology of type1diabetes
My technical report above with more than 20,000 reads is among the most read articles on ResearchGate. It was recommended by 3 diabetes experts and another diabetes expert, Dr. Joseph Cantor of the University of California San Diego added a comment in support.
MMR, TBE vaccine and type 1 diabetes
We have since published the general mechanism involved in autoimmunity induced by immunization with homologous xenogeneic antigens.
Arumugham V, Trushin M V. Cancer immunology, bioinformatics and chemokine evidence link vaccines contaminated with animal proteins to autoimmune disease: a detailed look at Crohn’s disease and Vitiligo. J
Hyle EP, Rao SR, Jentes ES, Parker Fiebelkorn A, Hagmann SH, Taylor Walker A, et al. Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations. Ann Intern Med. [Epub ahead of print 16 May 2017]167:77–84. doi: 10.7326/M16-2249
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Published: Ann Intern Med. 2017;167(2):77-84.
Published at www.annals.org on 16 May 2017
Infectious Disease, Prevention/Screening, Vaccines/Immunization.
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