Abstract
Molecular characterisation of measles virus is a powerful tool for tracing transmission. Genotyping may prove the absence of endemic circulation of measles virus, i.e. transmission for more than 12 months, which is one of the criteria for verifying elimination of the disease. We have genetically characterised measles viruses detected in Romania from 2008 to 2012, focusing on the recent outbreaks from 2010 to 2012 that affected mainly groups with limited access to healthcare and schools. The findings emphasise the importance of genotyping during the different phases of an outbreak. A total of 8,170 cases were notified, and 5,093 (62%) of the 7,559 possible cases were serologically confirmed. RT-PCR was performed for 104 samples: from the 101 positive samples obtained from sporadic measles cases or clusters from different counties, 73 were genotyped. Sporadic measles cases associated with D4 and D5 viruses were observed from2008 to 2009. Genotype D4-Manchester was predominant in 2011 and 2012. In addition, the related variant D4-Maramures and MVs/Limoges.FRA/17.10[D4] and a few D4-Hamburg strains were detected. The detection of several distinct MV-D4 genotypes suggests multiple virus importations to Romania. The outbreak associated with D4 genotype is the second largest outbreak in Romania in less than 10 years.
Highlights
Measles is a highly contagious respiratory viral disease characterised by the appearance of fever and a rash and that can be very serious or even fatal
This study describes the genetic characterisation of measles viruses detected in Romania from 2008 to 2012, focusing on the recent outbreaks that occurred in the country between 2010 and 2012 that affected mainly groups with limited access to healthcare facilities and schools
The 20 measles cases notified during 2008 to 2009 were attributed to MV-D4 and MV-D5 viruses imported from neighbouring countries and were not passed on to the general population
Summary
Measles is a highly contagious respiratory viral disease characterised by the appearance of fever and a rash and that can be very serious or even fatal. The World Health Organization (WHO) was forced to postpone a number of times the target date for measles elimination from the European region, most recently to 2015 [8]. The first monovalent measles-containing vaccine was introduced in 1979 into the Romanian vaccination schedule for children aged nine to 11 months. The combined measlesmumps-rubella (MMR) vaccine replaced the monovalent measles vaccine in 2004 and was recommended as a first dose for children aged 12 to 15 months. In the period from 2000 to 2010, the coverage for the first dose of measles vaccine was estimated at 95–98% [9]. In 2011, measles vaccination coverage for the first dose of MMR vaccine was estimated at 84% for children aged 12 months and 93.2% for those aged 18 months [10]
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