• Clinical and Experimental Vaccine Research
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• v.12 no.4
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• pp.298-303
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• 2023

Purpose: This qualitative study utilizing phenomenological methodology aimed to depict parental measles mumps rubella (MMR) vaccine acceptance through the work experiences of health personnel. Materials and Methods: Twenty-two public health workers working as vaccination providers in the three southern border provinces of Thailand were recruited. In-depth, face-to-face, semi-structured interviews were conducted. Data were analyzed using thematic analysis. Results: Four main themes emerged: (1) religious beliefs, (2) personal disagreements, (3) fear and mistrust regarding potential vaccine side effects, and (4) misperceptions about the potential severity of measles. Four subthemes were identified: (1) haram (prohibited), (2) the will of Allah, (3) spousal disagreement, and (4) disagreement from a religious leader. The results of this study indicated that perceived religious prohibition was the most important reason for refusing to vaccinate among Muslim parents. Vaccine-hesitant parents were concerned that the vaccine might contain gelatin derived from pig products. Also, halal certification of the vaccine was required from Muslim parents to ensure that vaccine has been approved for Muslims. Meanwhile, a lack of knowledge and positive attitudes concerning immunizations of vaccine-hesitant parents were also found as predominant reasons for incomplete childhood immunizations in the deep south of Thailand. Conclusion: Health education and engagement by religious leaders to endorse the vaccination and bridge the gap between religious beliefs and vaccine acceptance is needed to overcome this issue. This study findings could be effectively applied to improve vaccination uptake in a Muslim majority context.

• Clinical and Experimental Pediatrics
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• v.57 no.9
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• pp.396-402
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• 2014

Purpose: The introduction of the mumps vaccine has dramatically reduced the number of mumps cases, but outbreaks have recently occurred among highly vaccinated populations in developed countries. Epidemiological and clinical characteristics of patients with mumps admitted between 1989 and 2012 in a single hospital in Korea are described in the present study. Methods: We retrospectively evaluated inpatients with mumps between 1989 and 2012 and outpatients and inpatients with mumps in 2011-2012. Results: A total of 152 patients with mumps were admitted between 1989 and 2012, and 163 patients were recorded in 2011-2012. The highest number of admitted cases occurred in 1998 and 2012 (35 and 34 cases, respectively). Among the patients admitted in 2011-2012, the highest frequency was observed among people aged 15-19 years, and low frequency was observed in those aged <4 years and >20 years, compatible to the city data and national data. In patients admitted to our department in 1998 (35 cases) and in 2010-2012 (27 cases), there were significant differences in the mean age and the rate of secondary measles-mumps-rubella (MMR) vaccination, but had similar clinical features, including complications, except aseptic meningitis. Antimumps immunoglobulin (Ig) G was positive in 83% and 100%, and IgM was positive in 67% and 41%, respectively, in the two periods. Conclusion: In Korea, recent mumps outbreaks have occurred mainly among secondary school students who received two doses of the MMR vaccine. The vaccinees might have a modified immune reaction to viral insults, manifesting modified epidemiological and clinical features.

• 대한예방의학회:학술대회논문집
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• 2001.10a
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• pp.280-280
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• 2001

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.960-968
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• 2005

Purpose : This multi-center, open-label, clinical study was designed to evaluate the safety and immunogenicity of a trivalent, live, attenuated measles-mumps-rubella(MMR) vaccine, $Priorix^{TM}$ in Korean children. Methods : From July 2002 to February 2003, a total of 252 children, aged 12-15 months or 4-6 years, received $Priorix^{TM}$ at four centers : Han-il General Hospital, Kyunghee University Hospital, St. Paul's Hospital at the Catholic Medical College in Seoul, and Korea University Hospital in Ansan, Korea. Only subjects who fully met protocol requirements were included in the final analysis. The occurrence of local and systemic adverse events after vaccination was evaluated from diary cards and physical examination for 42 days after vaccination. Serum antibody levels were measured prior to and 42 days post-vaccination using IgG ELISA assays at GlaxoSmithKline Biologicals (GSK) in Belgium. Results : Of the 252 enrolled subjects, a total of 199 were included in the safety analysis, including 103 from the 12-15 month age group and 96 from the 4-6 year age group. The occurrence of local reactions related to the study drug was 10.1 percent, and the occurrence of systemic reactions was 6.5 percent. There were no episodes of aseptic meningitis or febrile convulsions, nor any other serious adverse reaction. In immunogenicity analysis, the seroconversion rate of previously seronegative subjects was 99 percent for measles, 93 percent for mumps and 100 percent for rubella. Both age groups showed similar seroconversion rates. The geometric mean titers achieved, 42 days pos-tvaccination, were : For measles, in the age group 12-15 months, 3,838.6 mIU/mL [3,304.47, 4,458.91]; in the age group 4-6 years, 1,886.2 mIU/mL [825.83, 4,308.26]. For mumps, in the age group 12-15 months, 956.3 U/mL [821.81, 1,112.71]; in the age group 4-6 years, 2,473.8 U/mL [1,518.94, 4,028.92]. For rubella, in the age group 12-15 months, 94.5 IU/mL [79.56, 112.28]; in the age group 4-6 years, 168.9 IU/mL [108.96, 261.90]. Conclusion : When Korean children in the age groups of 12-15 months or 4-6 years were vaccinated with GlaxoSmithKline Biologicals' live attenuated MMR vaccine ($Priorix^{TM}$), adverse events were limited to those generally expected with any live vaccine. $Priorix^{TM}$ demonstrated excellent immunogenicity in this population.

• Journal of Preventive Medicine and Public Health
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• v.38 no.4
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• pp.431-436
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• 2005

Objectives : We investigated the seroprevalence of the measles antibody and its at tributable factors for the students who underwent routine 2-dose Schedule Era. Methods : The subjects were 996 students of the national measles seroepidemiologic study in December 2000 who had vaccination records. We conducted a questionnaire survey and we performed serologic testing for the measlesspecific IgG by using an enzyme linked immunosorbent assay. Results : The coverage for the first dose of the MMR vaccination at 12-15 months of age was 95.1% and the coverage for the second dose of MMR at 4-6 years of age was 35.0%. The proportion of subjects undergoing 2-dosesof MMR dec reased as the age of the subjects increased. The seropositive rate of the measles antibody was significantly high in the second dose vaccinees (93.5% in the second dose group, 84.7% in the non-second dose group, p<0.001) and it was 72.0% in the 0-dose group, 85.4% in the 1-dose group and 93.7% in the 2-dose group (p<0.001). Two point eight percent of the subjects had a past history of measles infection. On the multiple logistic regression analysis, the first and second dose (odds ratio, 8.54; 95% CI.=3.05-23.91), the first dose (odds ratio, 3.06; 95% CI.=1.20-7.81) and the outbreak in the year 2000 (odds ratio, 1.89; 95% CI.=1.24-2.88) were the significant factors for the seropositivity. Conclusions : Maintaining high coverage with a 2-dose vaccination program would be the decisive factor to prevent an outbreak of measles and to eliminate measles in Korea.

• Journal of agricultural medicine and community health
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• v.23 no.2
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• pp.205-213
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• 1998

In order to find out the status of routine-immunization in a rural area, this study was performed, through analyzing the data which was obtained from the immunization register of infants who was born at Su-Dong myun in 1996 and 1997, managed by Su-dong Myun health subcenter. The results are as follows. 1. B.C.G immunization rate was the highest such as 52.2% within 1 month and next order such 34.8% at 2 month in 1996. In 1997, the highest such as 73.8%, almost all, within 1 month. 2. D.P.T immunization rate in 1996 showed, almost all, the highest at 3 month(79.4%) for 1st dose and at 5 month(78.4%) for 2nd dose. However, the rate for 3rd dose showed the highest at 7 month(51.4%), and next order at 8 month(35.1%) and at 6 month(13.5%). D.P.T immunization rate in 1997, similarly showed the highest at 3 month(81.8%) for 1st dose, at 5 month(71.2%) for 2nd dose and at 7 month(71.4%) for 3rd dose. 3. Hepatitis B immunization rate showed the highest at birth at once or within one week(87.0%) for 1st dose in 1996 and (94.7%) in 1997. The rate for 2nd dose showed the highest at 2 month(51.7%) in 1996 and (50.0%) in 1997, and next order at 1 month(44.8%) in 1996 and (34.4%) in 1997. The rate for 3rd dose showed the highest at 3 month(54.8%) in 1996 and 5 month(54.8%) in 1997, and next order at 5 month(25.8%) in 1996 and at 3 month(26.0%) in 1997. 4. Measles immunization rate was 76.1% in 1996. The rate(76.1%) by the kind of vaccine was the highest with measles-MMR(34.8%), and with MMR(32.6%) and next order with measles(8.7%). The rate by measles immunization time(month) was the highest such as 35.0% at 9 month and 10 month respectively and the rate by MMR was the highest at 16 month(35.5%), and 15 month(22.5%), 13 month (12.9%) and 14 month(12.9%) in next order.

• Clinical and Experimental Pediatrics
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• v.53 no.1
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• pp.67-71
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• 2010

Purpose : Recently, we have noticed an increase in the number of patients with mumps in Incheon, Korea. The aim of this study is to estimate the regional trend in mumps incidence and to evaluate the factors related to the recent increase. Methods : We reviewed the medical records of 66 patients with mumps who had been admitted to Incheon St. Mary's Hospital from July 1999 to June 2009. We compared the differences in records between "outbreak, 2009" and "nonoutbreak, 2000-2008." Results : Of the 66 patients, 35 (53%) were admitted in 2009, and 31 (47%) were admitted between 2000 and 2008. Most of the patients admitted during the outbreak were over 15 years of age (80.0%), were born before 1993 (77.1%), and had received a single dose of mumps vaccine (62.9%). There were no significant differences in contact history, present address, clinical manifestations, and complications, except for orchitis, between the two groups. Conclusion : There was a sharp increase in the number of inpatients with mumps who were born before 1993 and who were over 15 years of age. We recommend that a booster vaccination be considered for adolescents and young adults born before 1993 who are susceptible to mumps infection due to their reduced opportunities for receiving two doses of mumps vaccine.

• Pediatric Infection and Vaccine
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• v.6 no.2
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• pp.239-244
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• 1999

Purpose : In 1998, there was an outbreak of mumps in Taejon, Korea. We analyzed the monthly incidence, clinical manifestations, and complications during the outbreak and the annual incidence of the recent ten years. Methods : We reviewed the clinical records of 35 mumps patients who had been admitted to Taejon St. Mary's Hospital from January to December, 1998. Results : Mumps was prevalent in summer(from June to August) with 20 cases(57%). Thirthy-three patients(94.3%) received MMR at 15 months of age and no patients received a booster mumps vaccine. The mean age of the mumps patients was 10.5 years-old and the majority of mumps(71%) occurred between 5 and 12 year of age. The male female ratio was 2.2 : 1. The clinical manifestations were swelling of parotid gland(100%), fever (91%), vomiting(77%), abdominal pain(74%) and headache(66%) in order of frequency. Meningitis occurred in 20 cases(57%) and the mean WBC count of CSF was $464{\pm}263/mm^3$. In serology, the mean serum amylase level was $483{\pm}294IU/dL$ and anti-mumps IgM and IgG were positive in 11 and 15 out of 18 cases, respectively. From 1989 to 1997, the mean number of inpatients with mumps was 3.4 per year. Conclusion : We experienced an outbreak of mumps in 1998. It is suggested that there was a primary mumps vaccine failure in Korea and that further studies for vaccine faiure and method of booster mumps vaccine are necessary.

• Pediatric Infection and Vaccine
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• v.3 no.2
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• pp.175-184
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• 1996

Purpose : This study was intended to measure seropositivities and the levels of mumps- and rubella-specific IgG of MMR vaccinees over 17 months of age in Korea. Materials and Methods : From June 1994 to April 1995 we obtained sera from visitors of well baby clinic and patients in Korea University Hospital, who were MMR vaccinees over 17 months of age and had no evidence of immunodeficiency. These 275 study population include 145 males and 130 females. Mumps- and rubella-specific IgG antibody levels were measured by ELISA. Cut-off values for seropositivity were 20 GU(Gamma Unit) in mumps and 0.17 in rubella. Results : 1) As age increased, seropositivities of mumps-specific IgG increased significantly, being 69.0% in 1.5~2 year, 75.0% in 3~4 year, 76.0% in 5~6 year, 90.0% in 7 year, 100% in 8 year, 96.9% in 9 year, 97.4% in 10 year, 97.4% in 11 year, and 96.6% in 12 year of age(p<0.001). 2) As age increased, the levels of mumps-specific IgG antibody(mean${\pm}$standard deviation, GU) increased significantly, being $64.9{\pm}66.5$ in 1.5-2 year, $117.7{\pm}126.4$ in 3~4 year, $152.3{\pm}147.1$ in 5~6 year, $194.3{\pm}168.2$ in 7 year, $258.1{\pm}190.6$ in 8 year, $193.1{\pm}130.1$ in 9 year, $225.7{\pm}119.6$ in 10 year, $220.7{\pm}114.3$ in 11 year, and $222.3{\pm}127.1$ in 12 year of age(p<0.001). There was positive correlation between age and mumps-specific antibody level (r=0.3282, p<0.001). 3) As age increased, seropositivities of rubella-specific IgG decreased significantly, being 72.4% in 1.5~2 year, 75% in 3~4 year, 72% in 5~6 year, 60% in 7 year, 44.4% in 8 year, 40.6% in 9 year, 28.2% in 10 year, 23.1% in 11 year, and 17.2% in 12 year of age(p<0.001). 4) As age increased, rubella-specific IgG decreased significantly, being $0.462{\pm}0.356$ in 1.5~2year, $0.438{\pm}0.306$ in 3~4 year, $0.287{\pm}0.179$ in 5~6 year, $0.204{\pm}0.139$ in 7 year, $0.189{\pm}0.153$ in 8 year, $0.124{\pm}0.121$ in 9 year, $0.093{\pm}0.114$ in 10 year, $0.104{\pm}0.135$ in 11 year, and $0.080{\pm}0.001$ in 12 year of age(p<0.001). There was negative correlation between age and rubella-specific IgG titer (r=-0.551, p<0.001). Conclusions : Eventhough seropositivities and the level of mumps-specific IgG increased as age increased, they are not enough to prevent mumps infection in 1.5 to 6 years of age. Seropositivities and the level of rubella-specific IgG decreased as age increased. Appropriate change in vaccine schedule may be needed to decrease the risks of mumps and rubella infection.

• Clinical and Experimental Pediatrics
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• v.45 no.8
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• pp.980-986
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• 2002

Purpose : Although the number of patients with measles have dramatically decreased since the introduction of measles vaccines in 1965, measles outbreaks have occurred periodically every 4-6 years during the 1990s(1989-1990 and 1993-1994). During 2000-2001, measles prevailed all over the country again. A characteristic of current epidemics is that the majority of affected population was infants and school-aged children. This study was designed to analyze the epidemic and clinical features of measles prevalence during 2000-2001 and to find ways to overcome vaccination failure. Methods : We reviewed the records of 59 patients with mealses admitted in the Pediatric Department of Pusan National University Hospital from January 2000 to October 2001 for patient's age, month of admission, history of vaccination, clinical features and complications. Antibody titers of measles-specific IgM and IgG were measured by enzyme immunoassay. Results : The epidemic show two peaks in the age distribution. Forty three patients(72.9%) were under 2-years of age and 14 patients(23.7%) were over 5-years of age. Outbreaks had high incidence in July to August, 2000 and March to April, 2001, then faded away after July, 2001. Vaccinated group comprised 30.5% and unvaccinated group comprised 69.5% and their mean age was $9.25{\pm}4.27$ years old and $0.95{\pm}0.30$ years old respectively. Positive rate of IgM was 86.7% in vaccinated group and 90.3% in unvaccinated group. This means there was primary vaccine failure; 13 cases of 15 vaccinated patients were positive in IgM antibody. During the prevalence, two patients died with mealses complication. One of them was immunocompromised. Conclusion : To prevent another prevalence of measles in the future, we must enhance revaccination at ages 4-6 and check vaccination status when children enter elementary school. These will produce over 95% of herd immunity, with catch-up MMR vaccination which has been completed already.