Abstract
As a result of successful implementation of the measles/rubella elimination program, the etiology of more and more double negative cases remains elusive. The present study determined the role of different viruses as causative agents in measles or rubella suspected cases in Belarus. A total of 856 sera sent to the WHO National Laboratory between 2009 and 2011 were tested for specific IgM antibodies to measles virus (MV), rubella virus (RV) and human parvovirus B19 (B19V). The negatives were further investigated for antibodies to enterovirus (EV) and adenovirus (AdV). Children of up to 3 years were tested for IgM antibodies to human herpesvirus 6 (HHV6). A viral etiology was identified in 451 (52.7%) cases, with 6.1% of the samples being positive for MV; 2.6% for RV; 26.2% for B19V; 9.7% for EV; 4.6% for AdV; and 3.6% for HHV6. Almost all measles and rubella cases occurred during limited outbreaks in 2011 and nearly all patients were at least 15 years old. B19V, EV and AdV infections were prevalent both in children and adults and were found throughout the 3 years. B19V occurred mainly in 3–10 years old children and 20–29 years old adults. EV infection was most common in children up to 6 years of age and AdV was confirmed mainly in 3–6 years old children. HHV6 infection was mostly detected in 6–11 months old infants. Laboratory investigation of measles/rubella suspected cases also for B19V, EV, AdV and HHV6 allows diagnosing more than half of all cases, thus strengthening rash/fever disease surveillance in Belarus.
Highlights
Laboratory confirmation of measles and rubella started in Belarus in 2002
Positives were found for all six investigated pathogens and B19V, EV, AdV and human herpesvirus 6 (HHV6) were detected in each of the 3 consecutive years (Table 1)
A single measles case was found in 2009/2010, but in 2011 51 cases or 13.1% of all samples were positive for measles and this was the most frequent etiology after B19V in that year (Table 1)
Summary
Laboratory confirmation of measles and rubella started in Belarus in 2002. Serum samples from all suspected cases are investigated at the WHO National Laboratory for Measles and Rubella. During the elimination stage WHO recommends that countries demonstrate a sensitivity of their surveillance system of at least 2 suspected and discarded measles/rubella cases per 100 000 population per year [2]. With a decrease of measles and rubella incidence, the etiology of increasing numbers of double negative cases remains unknown. The confirmation of another infectious etiology would be of clinical interest, support the rejection of measles or rubella negative cases and improve the commitment of medical staff to report measles/rubella suspected patients
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