Laboratory-confirmed Measles Cases Research Articles

Breakthrough Measles among Vaccinated Adults Born during the Post-Soviet Transition Period in Mongolia.

Mongolia experienced a nationwide measles outbreak during 1 March 2015-31 December 2016, with 49,077 cases reported to the WHO; many were among vaccinated young adults, suggesting a possible role of vaccine failure. Advanced laboratory methods, coupled with detailed epidemiological investigations, can help classify cases as vaccine failure, failure to vaccinate, or both. In this report, we conducted a study of cases to identify risk factors for breakthrough infection for a subset of laboratory-confirmed measles cases. Of the 193 cases analyzed, only 19 (9.8%) reported measles vaccination history, and 170 (88%) were uncertain. Measles-specific IgG avidity testing classified 120 (62%) cases as low IgG avidity, indicating no prior exposure to measles. Ten of these cases with low IgG avidity had a history of measles vaccination, indicating primary vaccine failure. Overall, sixty cases (31%) had high IgG avidity, indicating breakthrough infection after prior exposure to measles antigen through vaccination or natural infection, but the IgG avidity results were highly age-dependent. This study found that among young children aged 9 months-5 years, breakthrough infection was rare (4/82, 5%); however, among young adults aged 15-25 years, breakthrough infection due to secondary vaccine failure (SVF) occurred on a large scale during this outbreak, accounting for the majority of cases (42/69 cases, 61%). The study found that large-scale secondary vaccine failure occurred in Mongolia, which highlights the potential for sustained outbreaks in post-elimination settings due to "hidden" cohorts of young adults who may have experienced waning immunity. This phenomenon may have implications for the sustainability of measles elimination in countries that remain vulnerable to the importation of the virus from areas where it is still endemic. Until global measles elimination is achieved, enhanced surveillance and preparedness for future outbreaks in post- or peri-elimination countries may be required.

Measles Outbreaks in the Republic of Congo: Epidemiology of Laboratory-Confirmed Cases Between 2019 and 2022.

In Africa, measles epidemics are frequently reported, despite numerous preventive measures, such as vaccination, which targets children under 5 years of age. Unfortunately, the Republic of the Congo is not an exception to this major health concern. Indeed, many cases are reported annually. Here, we provide an overview of the epidemiological characteristics of laboratory-confirmed measles cases from January 2019 to October 2022 as well as the risk factors associated with the occurrence of measles outbreak. Samples from suspected measles cases were collected across the country and sent to the National Laboratory of Public Health for confirmation. Specific IgM was tested using the enzyme-linked immunosorbent assay (ELISA). Data were analyzed using descriptive and analytic statistics (p < 0.05 was statistically significant). A total of 1330 samples were collected and analyzed. Over those 4 years, 537 samples were confirmed to be positive (40.3%) but with important disparities between years. A relatively low frequency of cases was reported in 2020. Overall, a progressive and significant evolution of positive cases was observed between 2019 and 2022, increasing from 16.8% in 2019 to 65.9% in 2022 (p < 0.0001). We report a low vaccination rate among children (44.8%) and a significantly high positivity rate in this group (46.6%) (p < 0.0008). No difference was reported according to the completeness of the vaccination scheme (p=0.094). Females were slightly more exposed to this infection than males (p=0.04; adjusted odds ratio [aOR]: 1.25 [1.01-1.6]), with an increased risk of exposure in rural areas (p=0.0001; aOR: 0.41 [0.32-0.53]). The department of Pointe-Noire had the highest positivity rate, while three other departments were considered high-risk areas: Likouala (p = 0.0001; aOR: 3.18 [1.80-5.61]), Pool (p=0.0001; aOR: 2.90 [1.70-4.95]), and Brazzaville (p=0.0005; aOR: 0.52 [0.36-0.75]). This study calls for strengthening the epidemiological surveillance system and vaccination strategy in the country. It remains important to research factors that induce a high positive rate among vaccinated children by biological verification of the immunization.

Trends of measles in Tanzania: A 5-year review of case-based surveillance data, 2018-2022

ObjectivesTanzania observed a gradual increase in the number of measles cases since 2019 with a large outbreak recorded during 2022. This study describes the trend of measles in Tanzania over a 5-year period from 2018-2022. MethodsThis was a descriptive study conducted using routine measles case-based surveillance system including 195 councils of the United Republic of Tanzania. ResultsBetween 2018 and 2022 there were 12,253 measles cases reported. Out of 10,691 (87.25%) samples tested by enzyme-linked immunosorbent assay, 903 (8.4%) were measles immunoglobulin M positive. The highest number of laboratory-confirmed measles cases was in 2022 (64.8%), followed by 2020 (13.8%), and 2019 (13.5%). Out of 1279 unvaccinated cases, 213 (16.7%) were laboratory-confirmed measles cases compared to 77/723 (10.6%) who were partially vaccinated and 71/1121 (6.3%) who were fully vaccinated (P < 0.001). Children aged between 1-4 years constituted the most confirmed measles cases after laboratory testing, followed by those aged 5-9 years. There was a notable increase in the number of laboratory-confirmed measles cases in children <1 year and 10-14 years during 2022 compared to previous years. The vaccination coverage of the first dose of measles-containing vaccine (MCV1) was maintained >90% since 2013 while MCV2 increased gradually reaching 88% in 2022. ConclusionsAccumulation of susceptible children to measles due to suboptimal measles vaccination coverage over the years has resulted in an increase in the number of laboratory-confirmed measles cases in Tanzania with more cases recorded during the COVID-19 pandemic. Strengthening surveillance, routine immunization, and targeted strategies are key to achieving the immunity levels required to interrupt measles outbreaks.

Resurgence of measles infection among children: findings from a surveillance-based population study

Background There has been a resurgence of measles infection in countries with high vaccination rates, including Malaysia. Understanding the geographical variation in measles resurgence and associated factors is important for measles prevention and control programs, especially where local information is scarce.&#x0D; Objective To determine the incidence of laboratory-confirmed measles infection and associated factors in the state of Melaka, in the southern region of Malaysia.&#x0D; Methods We obtained measles surveillance data for 4 years (January 2015 to December 2018) from the e-Measles national database. A comparative cross-sectional study was carried out on these data involving children who had been selected through convenience sampling.&#x0D; Results A total of 130 laboratory-confirmed measles cases and 213 non-measles cases were included in the study. Among the laboratory-confirmed cases, 56 (43.1%) had not been vaccinated against measles virus. Thirty-eight cases (51.4%) had received at least one dose of measles vaccine, while 36 cases (48.6%) had completed two doses of measles vaccination. There was a higher risk of contracting laboratory-confirmed measles among unvaccinated children (OR 19.39, 95%CI 8.82 to 42.6, P&lt;0.001) and children aged 8–18 years (OR 0.40, 95% CI 0.21 to 0.76, P=0.005)&#x0D; Conclusion Unvaccinated children and children aged 8–18 years have a higher risk of contracting laboratory-confirmed measles. The policy on routine immunization should be strengthened, the vaccine should be accessible to all children, and all children and adolescents should be given booster vaccinations.

Analysis of the direct economic burden of measles cases and its influencing factors in Shanghai from 2017 to 2019

Objective: To analyze the direct economic burden caused by measles cases in Shanghai from 2017 to 2019 and its influencing factors. Methods: A total of 161 laboratory-confirmed measles cases reported from January 1, 2017, to December 31, 2019, in Shanghai were included in the study through the "Measles Surveillance Information Reporting and Management System" of the "China Disease Surveillance Information Reporting and Management System". Through telephone follow-up and consulting hospital data, the basic information of population, medical treatment situation, medical treatment costs and other information were collected, and the direct economic burden of cases was calculated, including registration fees, examination fees, hospitalization fees, medical fees and other disease treatment expenses, as well as transportation and other expenses of cases. The multiple linear regression model was used to analyze the main influencing factors of the direct economic burden. Results: The age of 161 measles cases M (Q1, Q3) was 28.21 (13.33, 37.00) years. Male cases (56.52%) were more than female cases (43.48%). The largest number of cases was≥18 years old (70.81%). The total direct economic burden of 161 measles cases was 540 851.14 yuan, and the per capita direct economic burden was 3 359.32 yuan. The direct economic burden M (Q1, Q3) was 873.00 (245.01, 4 014.79) yuan per person. The results of multiple linear regression model analysis showed that compared with other and unknown occupations, central areas and non-hospitalized cases, the direct economic burden of measles cases was higher in scattered children, childcare children, students, and cadre staff in the occupational distribution, suburban areas and hospitalized, with the coefficient of β (95%CI) values of 0.388 (0.150-0.627), 0.297 (0.025-0.569), 0.327 (0.148-0.506) and 1.031 (0.853-1.209), respectively (all P values<0.05). Conclusion: The direct economic burden of some measles cases in Shanghai is relatively high. Occupation, area of residence and hospitalization are the main factors influencing the direct economic burden of measles cases.

Spatiotemporal Distribution and Genetic Characterization of Measles Strains Circulating in Greece during the 2017-2018 Outbreak.

Between May 2017 and November 2018, Greece has experienced a severe measles outbreak with a total of 3258 cases reported, after reaching its goal of eliminating measles since 2014–2015. In this study, we aimed to investigate the origin and the dispersal patterns of the measles strains that circulated in Greece during this outbreak and to identify possible transmission patterns of measles virus (MeV) in the country. Of the 832 measles suspect cases referred to the National Measles and Rubella Reference Laboratory for MeV RNA detection, 131 randomly selected positive samples, representative of the temporal and spatial distribution of the laboratory-confirmed measles cases in Greece, were processed for genotypic identification by an RT-PCR amplification of a 598 bp fragment containing the 450 bp hypervariable region of the measles virus N gene. Phylogenetic analysis was carried out by the approximate maximum likelihood method (ML) under the generalized time-reversible (GTR + cat) model. All samples analyzed were found to belong to genotype B3. Comparative analysis with other European and reference measles strains revealed three separate major clusters and other multiple viruses circulating simultaneously in Greece. They were all isolated from three main community groups, Greek-Roma children, non-minority Greek nationals and immigrants/refugees, a finding that is in accordance with what was also observed in the last two measles outbreaks in 2005–2006 and 2010–2011. Notably, for one of the three clusters, no similarity was detected with previously reported prototype strains. Our results indicate the need for a more intensive vaccination program against measles amongst minority populations and in refugee hot-spots as well as the importance of molecular surveillance as a tool for monitoring measles outbreaks.

Hospital Preparedness for a Community Measles Outbreak in Ribeirao Preto, Brazil

Background: Measles was considered eradicated in Brazil in 2016, but the virus reemerged in the country in 2018, causing large outbreaks. Ribeirao Preto has been measles free since 1997, but the outbreak in Sao Paulo City, 180 miles away in June 2019, alerted us to the possibility of measles patients coming to our emergency room (ER). The preparedness challenge was considerable: most healthcare workers (HCWs) had never seen a measles case before, and confirmatory measles laboratory tests were not readily available to us. Objective: To describe the hospital preparedness for the coming community measles outbreak. Methods: Hospital So Francisco is a 170-bed, general, tertiary-care hospital with 10,000 ER visits monthly. Measles preparedness consisted of measles training classes for HCWs, and flow charts with pictures and measles information in every ER office, also sent to HCW cell phones. We also designated areas for suspected measles patients for prompt medical evaluation; and we implemented mass measles vaccination for all hospital HCWs regardless of vaccination status, excluding pregnant or immunosuppressed HCWs. We considered a measles suspected case any person with fever, 1 of 3 symptoms (cough, coryza or conjunctivitis), and a generalized maculopapular rash with head-to-toe distribution. All contacts for suspected cases were recommended to obtain a measles vaccination. Detection of viral RNA in a biological sample and or a positive IgM result in serum was used to confirm a clinically suspected case. The study period spanned July 2019 to September 2019. Results: Measles training occurred for 3 weeks in July–August and reached 200 HCWs. The measles vaccination was offered July 23 to August 15; 1,362 HCWs were already vaccinated (93% of target population). In total, 35 clinical suspected measles cases were seen in the ER, and 3 of these were HCWs who had received the measles vaccine in their incubation period. Also, 3 patients were admitted to the hospital and 1 to the intensive care unit; there were no deaths. Overall, 8 patients had laboratory-confirmed measles, and 1,343 community contacts of these patients were vaccinated. We did not detect measles transmission to inpatients or to other HCWs after mass vaccination began. In the same period, Sao Paulo state had &gt;7,000 laboratory-confirmed measles cases and 12 deaths. Conclusions: Community measles outbreaks are a challenge for the hospital infection control team, and they can potentially disrupt the daily activities in the hospital. We were able to adequately prepare for the largest state outbreak in 20 years without secondary cases or deaths.Funding: NoneDisclosures: None

Analysis and Factors Associated with Measles in Larut, Matang and Selama Districts, Perak, Malaysia.

ObjectivesTo determine the incidence rate of measles and the factors associated with confirmed measles cases in Larut, Matang and Selama districts.MethodsCross-sectional analysis was carried out looking at all suspected and laboratory-confirmed measles cases in Larut, Matang and Selama districts between 2015 and 2019. Multiple logistic regression analysis was used to determine the associated factors for laboratory-confirmed measles cases.ResultsThe incidence rate for suspected measles showed an increasing trend from 2015–2019. For laboratory-confirmed measles cases, the incidence rate showed more variation with an increase to 36.11 per million population in 2017 from 5.67 per million population in 2015. The incidence rate later decreased to 10.99 per million population in 2018 and increased again to 24.47 per million population in 2019. From multiple logistic regression analysis, cases that fulfilled the case definition of measles were more likely to be laboratory-confirmed measles. On the other hand, a prior history of measles immunisation was a protective factor.ConclusionMeasles incidence is increasing in trend. Any suspected measles cases that fulfilled the clinical case definitions need to be further investigated. Immunisation should be promoted as they are effective in preventing and eliminating measles.

Vaccination Status and Socio-demographic Study of Laboratory Confirmed Measles Cases in Upazilla Hospitals of Bangladesh

Background: Though Bangladesh has done well to reduce the measles cases and measles related deaths through an effective vaccination programme, measles cases are still found in a good number in hospitals. The objectives of our study was to find out the vaccination status of laboratory confirmed measles patients and also to see the socio-demographic status of those patients.&#x0D; Methodology: This is a descriptive cross-sectional study conducted in five Upazilla Health Complexes (UHC) of Gazipur district during a period of one year from 01/01/2017 to 31/12/ 2017. The Upazillas included were Gazipur Sadar, Kaliganj, Kaliakair, Sreepur and Tongi. The suspected measles patients were admitted after taking history and clinical examination and confirmed by doing specific laboratory investigation. Measles vaccination status and sociodemographic status of the these confirmed cases were analysed by using SPSS version 21.&#x0D; Results: Blood samples were sent from 93 patients who were admitted during the study period after observing the diagnostic criteria of measles. Out of them 45 patients were confirmed as measles and they are included in the study. Among the laboratory confirmed measles, 28 cases (62.22%) were males and 17 (37.78%) cases were females, ratio of male and female was 1.6:1. The maximum number of patients (62.22%) were in the age group of 9 months to 4 years. Maximum patients came from low socioeconomic condition with a monthly income of 10,000- 15,000 taka. About maternal education, 26 mothers (57.78%) were uneducated, 12(26.67%) below primary and 7(15.55%) up or above primary level. Among the total patients, 27(60%) patients came with pneumonia, 16(35.56%) patients with both pneumonia and diarrhoea and 2(4.44%) patients only with diarrhoea. We found 32 patients (71.11%) received no MCV(Measles containing vaccine) , 11 patients (24.44%) with one MCV and 2 patients (4.44%) received two MCVs. There we found several causes of dropout of measles vaccine. Lack of awareness regarding one vaccine was the most common cause (42.22%) and then ignorance about two measles vaccine (28.89) followed by migration (17.78%) and parental occupation (11.11%). History of contact with measles patients were found in 24.44% cases , no history in 26.67% cases and in 48.89% cases the history of contact is unknown.&#x0D; J Shaheed Suhrawardy Med Coll, December 2019, Vol.11(2); 86-90

MEASLES IN LARUT, MATANG AND SELAMA: ANALYSIS AND EVALUATION OF CLINICAL CASE DEFINITIONS FOR 2015-2019

An accurate system of identifying measles cases is critical for the measles surveillance system. The objectives were: 1) To determine the incidence rate of measles in Larut, Matang and Selama district in Perak from 2015 to 2019 2) To evaluate the measles clinical case definition by comparing the performance of the measles clinical case definition in predicting laboratory-confirmed measles case. A cross-sectional analysis was carried out looking at all suspected and laboratory-confirmed measles cases in Larut, Matang and Selama District registered on the online measles surveillance reporting system between 2015 to 2019. The sensitivity, specificity, positive predictive value and negative predictive value of the clinical case definition as confirmed by the laboratory result were calculated. The incidence rate for suspected measles showed an increasing trend from 3.96 per 100,000 population in 2015 to 28.82 per 100,000 population in 2019. For laboratory-confirmed measles cases, the incidence rate showed more variation with an increase to 36.11 per million population in 2017 from 5.67 per million population in 2015. The incidence rate later decreased to 10.99 per million population in 2018 and increased again to 24.47 per million population in 2019. The sensitivity of the clinical case definition in confirming measles was 86.67% (95% CI: 69.28%, 96.24%) , specificity 47.52% (95% CI: 41.56%, 53.52%), positive predictive value 14.95% (95% CI 12.81%, 17.36%) and negative predictive value 97.10% (93.03%, 98.83%). Measles incidence is increasing in trend. The clinical case definition is an effective tool to rule out measles in cases that failed to meet the criteria due to the high negative predictive value of the definition. However, for cases that meet the clinical case definition, laboratory confirmation or epidemiological link to a confirmed case is needed.

Classification of measles cases from 2014 to 2018: Implications for progress towards measles elimination in China

Measles incidence has decreased dramatically in China due to the implement of measles-containing vaccine (MCV). However, a measles epidemic caused resurgence recently, even among vaccinated individuals. To evaluate the effectiveness of current immunization programs and discuss initiatives for the next step in measles elimination in mainland China, the characteristics of 121,969 laboratory-confirmed measles cases reported in the measles surveillance system (MSS) during 2014–2018 were analyzed according to the vaccination status of the cases in this study.Children under 2 years of age without MCV vaccination (44,424, 36.42% of all cases) and adults over 20 years of age with an unknown vaccination history (37,564, 30.80% of all cases) accounted for the majority of measles cases from 2014 to 2018. 42,425 (34.78%) of the 77,384 cases with available vaccination information were categorized as programmatically preventable. 38,840 (91.55%) of the 42,425 cases were aged ≥8 months without the MCV vaccination history. 34,959 (28.66%) cases were categorized as programmatically non-preventable, of whom 22,611 (64.68%) were too young to receive their first MCV dose, 6857 (19.61%) received their first dose and were too young to receive their second dose, 5491 (15.71%) received at least two doses of MCV.15,933 (13.06%) of the 121,969 cases had a history of MCV vaccination. Measles virus infection in cases with an MCV vaccination history mainly occurred within the first month after MCV vaccination, especially in those who received a one-dose measles vaccination. MCV vaccination could reduce the frequencies of clinical symptoms and complications of measles cases.Our study confirmed that the current measles immunization programs used in mainland China is effective in reducing the measles incidence in China. Unvaccinated infants/children aged 8–23 months and high risk susceptible adults over 20 years of age with unknown vaccination histories should be the focus groups of measles immunization activities in China in the future.

What have we learnt from measles outbreaks in 3 English cities? A qualitative exploration of factors influencing vaccination uptake in Romanian and Roma Romanian communities

BackgroundSince 2016, large scale measles outbreaks have heavily affected countries across Europe. In England, laboratory confirmed measles cases increased almost four-fold between 2017 and 2018, from 259 to 966 cases.Several of the 2017–18 measles outbreaks in England particularly affected Romanian and Roma Romanian communities, with the first outbreaks in these communities occurring in Birmingham, Leeds and Liverpool. This study explored factors influencing vaccination behaviours amongst Romanian and Roma Romanian communities in these three cities.MethodsAcross Birmingham, Leeds and Liverpool, we conducted semi-structured interviews with 33 key providers to explore their experience in delivering vaccinations and managing the outbreak response. We also interviewed 9 Romanian women in one of the cities to explore their vaccination attitudes and behaviours. To categorise factors affecting vaccination we applied the 5As Taxonomy for Determinants of Vaccine Uptake (Access, Affordability, Awareness, Acceptance and Activation) during data analysis.ResultsFactors related to access and acceptance, such as language and literacy, ease of registering with a general practice, and trust in health services, were reported as the main barriers to vaccination amongst the communities. Concerns around vaccination safety and importance were reported but these appeared to be less dominant contributing factors to vaccination uptake. The active decline of vaccinations amongst interviewed community members was linked to distrust in healthcare services, which were partly rooted in negative experiences of healthcare in Romania and the UK.ConclusionAccess and acceptance, dominant barriers to vaccination, can be improved through the building of trust with communities. To establish trust providers must find ways to connect with and develop a greater understanding of the communities they serve. To achieve this, cultural and linguistic barriers need to be addressed. Better provider-service user relationships are crucial to reducing vaccination inequalities and tackling broader disparities in health service access.

Measles Ring Vaccination in Dormitories: An Outbreak Containment Measure and Simulation Study

Background: Two measles outbreaks occurred in migrant worker dormitories in Singapore in 2019. We report the outbreak investigation and use of ring vaccination to contain transmission. Methods: We collected clinical and epidemiological data from laboratory-confirmed measles cases and conducted field investigations to examine the interactions between dormitory residents. Two measles seroprevalence studies were performed using 1136 residual sera obtained from Bangladeshi, Chinese and Indian workers previously enrolled in 2016-19 for a study on latent tuberculosis and 101 samples prospectively collected from healthy workers residing on the same level as the index cases. We administered measles, mumps and rubella vaccine to close contacts and dormitory residents residing on the same level as a case (ring vaccination). The effectiveness of ring vaccination in a dormitory of varying contact patterns and population immunity was also evaluated using simulation models. Findings: From Jun 14 to Jul 29, 2019, there were 12 laboratory-confirmed cases of measles from two distinct dormitory outbreaks and 214 close contacts along with 1532 dormitory residents were vaccinated. Measles Immunoglobulin G was detected in 99.5% (95% CI 98.9 – 99.8) of the residual sera and in all blood samples. Outbreaks simulated in a dormitory of 24 194 people, with 90% immunity and an average of 25 contacts per person, revealed a significant reduction in the final outbreak size from 2026 (IQR 1986–2058) cases to 8 (IQR 3– 26) cases when ring vaccination was implemented. In addition, vaccinating each person would avert two new cases. At higher population immunity of 93% and an average of 15 contacts per person, the maximum outbreak size was reduced by 50% with ring vaccination. Interpretation: Measles outbreaks can occur in densely populated areas with high contact rates despite high population immunity. Ring vaccination may be a strategy to protect susceptible contacts to minimise the risk of large outbreaks. Funding Statement: The authors stated: None. Declaration of Interests: The authors declare no competing interest. Ethics Approval Statement: All epidemiological investigations and outbreak containment measures were implemented under the Infectious Diseases Act, which provides for the use of outbreak investigation data for analysis and evaluation.

Were infections in migrants associated with the resurgence of measles epidemic during 2013–2014 in southern China? A retrospective data analysis

ObjectiveThe 2009 province-wide and 2010 nationwide supplementary immunization activities (SIAs) greatly reduced measles prevalence in Guangdong, a province in southern China with the largest migrant population. However, during 2013–2014, Guangdong experienced a resurgence of the measles epidemic. This study was performed to examine the association between infections in migrants and the resurgence of the measles epidemic. MethodsThe records of 22 362 clinically and laboratory-confirmed measles cases from the years 2009 to 2014 were extracted from the National Infectious Disease Monitoring Information System. The epidemiological characteristics of infections in migrants during 2009–2012 were compared to those during 2013–2014. ResultsInfections in migrants were not significantly associated with the resurgence of the measles epidemic in 2013–2014 (p=0.98). Nevertheless, for infections among locals and migrants during 2009–2012 and 2013–2014, substantial increases in the proportion of infection were detected among children aged <8 months and the unvaccinated population (p<0.01). ConclusionsThe study findings suggest that infections in migrants might not have been the major cause of the epidemic resurgence of measles. Instead, the resurgence was likely due to infections among children aged <8 months and the unvaccinated. Thus, officials are advised to give higher priority to appropriate populations when formulating control measures, and to strengthen routine surveillance of vaccination coverage among them.

The importance of serological and molecular analyses for the diagnosis of measles cases and for meeting elimination targets in Turkey from 2007 to 2015.

Measles is an important childhood infection targeted to be eliminated by the World Health Organization (WHO). Virus circulation has not been interrupted in the European Region because high vaccination rates could not be achieved among some countries of the WHO European Region including Turkey. The purpose of this study was to evaluate the laboratory findings of measles cases confirmed in the last nine years, to assess the epidemiological data of the cases, to determine the molecular genotyping studies and to emphasise the importance of laboratory-based surveillance in measles. From 2007 to 2010, only 18 imported cases were detected in Turkey. However, this number increased with a local outbreak of 111 cases in 2011, followed by another outbreak in 2012 in Istanbul that spread countrywide in the following two years; a total of 8661 laboratory-confirmed measles cases were reported from 2012 to 2015. After ELISA detection of a measles IgM-positive result in serum samples of potential measles cases, RT-PCR was performed with urine or nasopharyngeal swab samples of patients, and amplicons were subjected to sequencing. In the samples of 2010 and 2011, D4 and D9 genotypes were mainly detected; as of 2012, the D8 genotype has gained importance. Although D8 was also identified in 2014, in the same year genotype H1 viruses were detected in Turkey for the first time. Therefore, it is important to perform a genotypic analysis of the virus causing the outbreak, analyse epidemiological connections of the contact, determine the source of the outbreak and plan measures based on this information.

Epidemiology of laboratory confirmed measles virus cases in the southern nations of Ethiopia, 2007\u20132014

BackgroundIn Ethiopia, measles case-based surveillance was introduced in 2004 as one strategy for measles control by laboratory confirmation of suspected cases. In this article, epidemiological distribution of laboratory-confirmed measles cases were reported from the Southern Nation Nationalities and Peoples Region (SNNPR) of Ethiopia between 2007 and 2014, as the region is one of the highly measles affected areas in Ethiopia.MethodA serum sample was collected from all measles suspected cases, and patient information was captured by case reporting format (CRF). Samples were transported to the National Measles Laboratory for Measles IgM testing by ELISA technique. Data entry and analysis were done using Epi-Info 3.5.4 software.ResultA total of 4810 samples were tested for measles IgM using ELISA technique and 1507 (31.3%) were found positive during 2007–2014 in SNNPR of Ethiopia. Patients with age 1–4 years were the most affected regardless of sex. The incidence of measles confirmed cases increased from 15 in 2007 to 180 in 2013 per million population. The highest percentage of laboratory-confirmed cases were found in 2014. Measles was found distributed throughout the regional state.ConclusionMeasles was found a public health important disease in SNNPR of Ethiopia, mostly affecting children 1–4 years. The incidence of measles cases is increasing from time to time. Additional research to determine the genotype of circulating measles virus, knowledge, attitude and practice of professionals and the population for measles vaccination and infection in the region is important. A wide age group measles vaccination campaign is highly recommended.

Epidemiology of laboratory confirmed measles virus cases in Amhara Regional State of Ethiopia, 2004-2014.

BackgroundMeasles is a highly contagious viral infection causing large outbreaks all over the world. Despite the availability of safe and cost effective vaccine, measles remained endemic with persistent periodic outbreaks in the Horn of Africa. The aim of this study is to characterize laboratory confirmed measles cases in Amhara Regional State, which was one of the highly affected regions in Ethiopia.MethodA suspected measles case was defined as any person presenting with fever, maculopapular rash and one or more of the three symptoms cough, coryza or conjunctivitis or a patient in whom a clinician suspects measles. A blood sample was collected for any measles suspected patient with a case based investigation form and specimen transported to the National Measles Laboratory in good condition where it was to be tested for Measles IgM antibody by ELISA technique. Data was entered and analyzed using Epi-Info 3.5.4 software.ResultA total of 6579 samples were tested for measles IgM among 7296 samples collected in Amhara Regional State over 11 years (2004–2014). Of the tested samples, 2412 (36.7 %) were found positive, while 3965 and 202 samples were found to be negative and equivocal (compatible) respectively. Patients with age ≥10 years were the most affected. The highest number of laboratory confirmed measles cases were detected in 2014 and cases were occurred in all of the 11 zones of the state. A seasonal peak was noted in the hot-dry season of the year.ConclusionMeasles remains to be a public health problem in Amhara Regional State of Ethiopia, mostly affecting people ≥10 years of age. Measles virus was detected in all zones of the state, reaching its peak in the hot-dry season. To reduce the incidence of measles, it is highly recommended to improve routine immunization, and conduct a wide age group campaign.Additional research to evaluate the knowledge, attitudes and practices of the general population and health care professionals about measles infection and vaccination is important. Genotyping of circulating measles virus strain is recommended.

Measles Outbreak Associated with Vaccine Failure in Adults--Federated States of Micronesia, February-August 2014.

On May 15, 2014, CDC was notified of two laboratory-confirmed measles cases in the Federated States of Micronesia (FSM), after 20 years with no reported measles. FSM was assisted by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and CDC in investigating suspected cases, identify contacts, conduct analyses to guide outbreak vaccination response, and review vaccine cold chain practices. During February–August, three of FSM’s four states reported measles cases: Kosrae (139 cases), Pohnpei (251), and Chuuk (3). Two thirds of cases occurred among adults aged ≥20 years; of these, 49% had received ≥2 doses of measles-containing vaccine (MCV). Apart from infants aged <12 months who were too young for routine vaccination, measles incidence was lower among children than adults. A review of current cold chain practices in Kosrae revealed minor weaknesses; however, an absence of historical cold chain maintenance records precluded an evaluation of earlier problems. Each state implemented vaccination campaigns targeting children as young as age 6 months through adults up to age 57 years. The preponderance of cases in this outbreak associated with vaccine failure in adults highlights the need for both thorough case investigation and epidemiologic analysis to guide outbreak response vaccination. Routine childhood vaccination coverage achieved in recent years limited the transmission of measles among children. Even in areas where transmission has not occurred for years, maintaining high 2-dose MCV coverage through routine and supplemental immunization is needed to prevent outbreaks resulting from increased measles susceptibility in the population.

Study on the risk factors of measles among the 8-month-olds and children≥15 years of age in Gansu province

To understand the risk factors of measles among babies under 8-months-old and people ≥15 years old, in Gansu province. Laboratory-confirmed measles cases were divided into two groups among children below 8-months-old and those ≥15 year olds. Descriptive epidemiology and 1:3 case control study were conducted to find out those related risk factors as:hospital exposure, contact with measles cases, vaccination, history of measles etc. so as to determine the risk factors and appropriate control measures. Histories of hospital exposure, contact with measles cases and travelling to other cities were risk factors for measles among babies younger than 8-months and people ≥15 year olds. Vaccination appeared a protective factor for people ≥15 years of age. From 42 cases and 126 controls, through multivariate analysis, results showed that hospital exposure was the only significant factor ( OR = 29.23, 95%CI:2.82-302.89)for those babies younger than 8-months. Factors as hospital exposure and travelling among cities for 7-21 days before being infected, were with significant importance ( OR = 5.15, 95% CI:2.28-11.63; OR = 5.48, 95%CI:1.38-21.69)for people ≥15 years of age, according to the observation from 74 cases and 222 controls. In order to reduce the incidence of measles among babies under 8-month-old and people ≥15 years old, efforts on control of nosocomial infection should be strengthened, while the routine immunization coverage need to be increased for the children at higher risks, to reduce the source of infection.

Seroepidemiology and phylogenetic characterisation of measles virus in Ireland, 2004–2013

BackgroundIreland is classified as an area of high measles incidence. A World Health Organisation-European Region strategic plan exists for measles elimination by 2015. ObjectivesTo retrospectively investigate measles outbreaks using all patient samples (sera and oral fluid) received for measles laboratory diagnosis and characterise the genetic diversity of circulating measles genotypes in Ireland. Study Design704 cases of acute measles infection as determined by the presence of measles specific IgM in sera and oral fluids were confirmed at the National Virus Reference Laboratory. Measles positive samples (n=116) were examined by genotyping, sequence analysis and phylogenetic characterisation. ResultsThree measles outbreaks occurred over the study period: 2004, 2009/2010 and 2011. Measles IgM positivity ranged from 22–29% in outbreak years to 5–10% in the intervening years. Age profile analysis revealed that whereas individuals >10 years accounted for only 8% of cases in the 2004 outbreak, this increased to 33% and 29% in the 2009/2010 and 2011 outbreaks, respectively. The <1 year cohort accounted for 18–20% of cases in all outbreaks. Phylogenetic analysis demonstrated both indigenous transmission and also importation events. Clade D viruses were exclusively found circulating in Ireland, with autochthonous transmission of diverse genotype D4 strains associated with large outbreaks across Europe. More recently, genotype D8 was identified and these were associated with importation events. ConclusionsThis study provides a comprehensive genetic analysis of circulating measles genotypes in Ireland and discriminated between indigenous and imported viral strains. Notably, an increase in laboratory-confirmed measles cases in the greater than 10 years of age group was seen over the study period. This information is valuable to inform vaccination strategies with a focus on those populations who remain susceptible to measles infection.