Abstract
This study describes 33 laboratory-confirmed cases of measles that occurred in Norway in 2011, mainly among unvaccinated children between seven months and 10 years of age. Laboratory testing included detection of anti-measles IgM- and IgG antibodies by enzyme-linked immunosorbent assay (ELISA) and molecular detection and characterisation of measles virus by polymerase chain reaction (PCR) and sequencing. Epidemiological data and genotyping revealed that the measles cases originated from eight separate importations, resulting in four outbreaks and four sporadic cases. Except for the first outbreak which affected 18 cases, limited secondary spread occurred in each of the three other outbreaks. The outbreaks were caused by measles virus genotypes B3, D4 and D9, whereas genotypes D8 and B3 were detected in the sporadic cases. This study highlights that genetic characterisation of measles virus is an essential tool in the laboratory surveillance of measles, especially in countries like Norway which are approaching the measles elimination goal. The investigation revealed that importation of measles resulted in subsequent transmission within Norway to non-vaccinated individuals, and twelve cases occurred in healthcare settings, involving both staff and children. The four cases detected among healthcare workers (HCWs) emphasised that the coverage of measles-mumps-rubella (MMR) vaccination among healthcare personnel needs to be improved and both primary and secondary vaccine failure was demonstrated in two fully immunised HCWs.
Highlights
Measles, a highly contagious respiratory viral disease characterised by the appearance of fever and a rash, is the leading cause of vaccine-preventable childhood mortality worldwide [1]
The target date for elimination of measles in Europe has been changed a number of times, and due to widespread outbreaks occurring in both eastern and western Europe (Austria, Bulgaria, France, Germany, Romania, Switzerland, and the United Kingdom (UK)) [3] the World Health Organization (WHO) Regional Office for Europe most recently (2010) changed the target date from 2010 to 2015 [3,4]
In Norway, the WHO National Reference Laboratory for Measles and Rubella is located at the Norwegian Institute of Public Health (NIPH) where samples obtained from suspected and notified measles cases are routinely sent for confirmation
Summary
A highly contagious respiratory viral disease characterised by the appearance of fever and a rash, is the leading cause of vaccine-preventable childhood mortality worldwide [1]. The incubation time is between 10 and 14 days, and a measles infected person is contagious from four days before to four days after the rash appears. The target date for elimination of measles in Europe has been changed a number of times, and due to widespread outbreaks occurring in both eastern and western Europe (Austria, Bulgaria, France, Germany, Romania, Switzerland, and the United Kingdom (UK)) [3] the WHO Regional Office for Europe most recently (2010) changed the target date from 2010 to 2015 [3,4]. In order to prevent outbreaks, a measles vaccine coverage of 95% for two doses of vaccine is needed [6]. In Europe, personal attitudes toward vaccination are factors that influence the vaccination coverage, which is variable [3]
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