Measles Elimination Program Research Articles

Case Study: Contribution of Extended Sequencing and Phylogeographic Analysis in the Investigation of Measles Outbreaks in Tunisia in 2019.

Despite the availability of an effective vaccine for several decades, the measles virus continues to spread worldwide. From 2018 to 2019, several countries experienced large measles outbreaks with genotype B3, including Tunisia. We analyzed 66 samples collected from serologically confirmed measles cases during this outbreak. Fifty-five percent were aged less than 12 months and had not received a measles vaccine. Phylogenetic analysis using the 450 nucleoprotein (N450) window revealed that all strains belonged to genotype B3, with five different variants identified. The N450 sequence of the predominant one, which circulated all through the epidemic period, was identical to the named strain MVs/Kabul.AFG/20.14/3. For better molecular discrimination, the amplification and sequencing of 1018 nucleotides in the non-coding region between the M and F genes (MF-NCRs) revealed higher variability with at least nine clusters. A phylogeographic study using Bayesian methods suggested the Governorate of Kasserine (on the borders of Algeria) as the introduction point with a TMRCA (Time to Most Recent Common Ancestor) for the 2019 sequences estimated around October 2018. These findings emphasize the crucial role of advanced molecular investigations in tracing measles transmission pathways which, together with good vaccine coverage, will help the final success of the global measles elimination program.

Measles Seroprevalence in Healthcare Professionals During the Measles Elimination Program: A Cross-Sectional Study

Measles Seroprevalence in Healthcare Professionals During the Measles Elimination Program: A Cross-Sectional Study

Polish Legislation and Health Policy against the Background of Achievement of the Assumptions and Objectives of the Measles Eradication Programme in the European Region

Abstract The measles elimination programme in the European region set up by the World Health Organization was a response to the real risk of a measles epidemic in Europe. The ideas of the programme were to be integrated into national regulations to effectively counteract this threat. The end of the programme in 2020 opens the door for discussion on the further need to refine legislative and organisational solutions for measles prevention. This is even more justified as new measles outbreaks have been observed in the European region since 2018. Poland was one of the countries in the European region to take legislative action to protect public health after 2008. However, it was only the COVID-19 pandemic that led to numerous amendments to the national legal order. This raises the question of the effectiveness and quality of national regulations against measles. This article analyses selected national regulations in relation to the objectives of the measles elimination programme in the European region. The assessment shows the need for further improvement of national legislation, as well as the need to extend the measles elimination programme in the European region to coordinate national efforts.

The Error in the Infectious Period of Measles in the Circular Concerning Measles Elimination Program

The Error in the Infectious Period of Measles in the Circular Concerning Measles Elimination Program

Measles in Poland in 2020.

Measles is a disease under the elimination program coordinated by the World Health Organization (WHO). The elimination of measles in the country is possible provided that 95% of the population is vaccinated with two doses of the vaccine, the epidemiological situation is monitored, all suspected cases of measles are recorded, and laboratory diagnostics are conducted by the WHO Reference Laboratory. Polish Reference Laboratory is located at the Department of Virology NIPH NIH - NRI. The aim of the article is to analyze the epidemiological situation of measles in Poland in 2020 with presenting the measles vaccination coverage and the progress of the measles elimination programme in Poland. The epidemiological situation of measles in Poland was analyzed on the basis of the case-based questionnaires of cases suspected of measles sent to NIPH NIH - NRI by the Sanitary and Epidemiological Stations, data from the publications: "Infectious diseases and poisonings in Poland in 2020" and "Vaccinations in Poland in 2020". In 2020, 29 cases of measles were notified to the surveillance system in Poland (incidence 0.08 per 100,000 population). The highest incidence was observed in the aged 0-4 was estimated at 0.42 per 100,000 population. Out of all cases, 9 (31%) were hospitalized. No fatal cases due to the measles were reported. The epidemiological situation of measles in 2020 in comparison with the situation in 2019, has improvement. This was a trend in throughout Europe.

The role of the nurse in measles prevention

During the implementation of the measles elimination program in the Russian Federation, active detection of all cases of measles is of great importance. With the help of government and international programs, in which WHO participates, and others in which the World Red Cross is involved, the efforts of nurses and other health workers are helping to increase measles vaccination rates and prevent the spread of this dangerous infection. Some countries also face problems of negative public attitudes towards vaccination, which can lead to low coverage and spread of diseases. Nurses must convince the population of the need for vaccination and combat myths and misinformation about vaccines. Nurses play an important role in the fight against measles and other infectious diseases through the organization and administration of vaccinations, community education and disease data collection.

Measles outbreak in the sanitary area of Guadalajara (Spain): difficulty in microbiological diagnosis in the era of its elimination

IntroductionIn Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tolos for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). MethodsSerological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. ResultsA total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in two that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or two vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. ConclusionsThe combination of molecular tests and the presence of specific IgM is necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.

Five-Year Trend of Measles and Its Associated Factors in Pahang, Malaysia: A Population-Based Study.

Measles is a disease that has resurfaced as a public health concern in Malaysia. Malaysia has had a Measles Elimination Program in place since 2004, but the incidence of measles in Pahang has not improved significantly. The purpose of this study was to describe the incidence and trend of measles in Pahang, as well as to identify the risk factors. The five-year population-based surveillance data of the entire Pahang state was extracted and analyzed for the trend and incidence of measles from January 2016 to December 2020. Multiple logistic regression was used to examine the relationship between measles and available sociodemographic data. A total of 2844 reported measles cases were investigated. Out of the measles cases reported, 7.41 percent were confirmed. According to the five-year fluctuating trend, the incidence rate ranges from 13.51 to 50.97 per 1,000,000 population. Confirmed measles was significantly associated with an indigenous background (AdjOR = 4.90, 95% CI: 1.74, 13.78), history of contact with measles cases (AdjOR = 14.03, 95% CI: 8.23, 23.90), and incomplete vaccination (AdjOR = 3.38, 95% CI: 2.28, 5.01). In conclusion, the incidence of measles in Pahang remains sporadic, owing to sporadic outbreaks. Vaccination is an important preventive measure that must reach out to the isolated populations such as indigenous people.

Improvement of epidemiological diagnosis in the system of epidemiological surveillance of current infections by creating a database of the results of foci investigation

Measles is one of the preventable infections that does not lose its relevance to this day. In Russia, as well as throughout the world, waves of an increase in the incidence of measles are still being recorded, so in 2019 the maximum incidence rate over the past 20 years (3.05 %ооо) was noted. According to the current Measles Elimination Program of the Russian Federation, each case of this infection is subject to investigation, based on the results of which the epidemiologist organizes measures to prevent its spread in the outbreak. The main anti-epidemic measures in this case are isolation of the patient (at home or in a hospital according to clinical indications) and vaccination of persons in contact with him who need it. Thus, in order to prevent the occurrence of secondary cases, it is necessary to determine the vaccination and infectious history of all persons in contact with the sick person and vaccinate them no later than the seventh day from the moment the outbreak was registered. To date, it is difficult to generalize data from investigations of measles cases, despite their value for epidemiological diagnosis and the development of epidemiological surveillance (ES) tactics. The aim of the work was to improve the information support for the investigation of measles cases by creating and analyzing a database. The authors proposed a method for summarizing and analyzing the results of the investigation of measles cases using the formation of a database. For this purpose, about 1000 acts and reports on the results of the investigation of measles foci (on paper) registered in Moscow in the period from 2013 to 2015 were analyzed. The data contained in these documents is entered into the database, systematized in separate blocks and processed by the appropriate software for the purpose of their subsequent accumulation, storage and analysis. Based on the results of the work, the age composition of measles patients was analyzed. It was found that children under 18 years of age were more likely to have this infection, while the largest share among them was in persons aged 3–6 (32.4 %) and 7–14 years (25.0 %). The use of the database made it possible to confirm the high epidemiological effectiveness of the measles vaccine — the protection factor (E) was 86 %. Using the database, it was found that adults aged 20–35 years old were most actively vaccinated in measles foci (vaccination coverage was 57.7 %). With the threat of this infection, only 25.9 % of children (under 17 years old) who needed vaccination agreed to be vaccinated, and the percentage of refusals varied from 69.8 % in the age group up to two years old to 42.3 % in the group 20–35 years old.

Measles in Poland in 2019.

Since 1998 Poland has endorsed measles elimination programme which is coordinated by the World Health Organization (WHO). To accomplish measles elimination in the country, achievement of vaccination coverage at 95% in the population is needed, as is the monitoring of the epidemiological situation, i.e.: reporting on cases suspected of measles and conducting laboratory diagnostics in WHO Reference Laboratory. Polish Reference Laboratory is located at the Department of Virology NIPH NIH - NRI. The aim of the article is to analyze the epidemiological situation of measles in Poland in 2019 with presenting the measles vaccination coverage and the progress of the measles elimination programme in Poland. The epidemiological situation of measles in Poland was analyzed on the basis of the case-based questionnaires of cases suspected of measles sent to NIPH NIH-NRI by the Sanitary and Epidemiological Stations, data from the publications: "Infectious diseases and poisonings in Poland in 2019" and "Vaccinations in Poland in 2019". In 2019, 1,502 cases of measles were notified to the surveillance system in Poland (incidence 3.91 per 100,000 population, more than four times more than in 2018). The highest incidence was observed in the aged 35-39 was estimated at 11.36 per 100,000 population. Out of all cases, 772 (51.4%) were hospitalized. No fatal cases due to the measles were reported. In 2019 the maintenance of high vaccination coverage among children aged 2 and 12 years old was observed - from 92.6% to 99.5% (primary vaccination, children born in 2009-2017). The epidemiological situation of measles in 2019 in comparison with the situation in 2018, has deteriorated. This was a trend in throughout Europe.

Molecular identification and characterization of measles virus genotypes circulating in Afghanistan, 2008-2018.

The measles virus (MV) remains a leading cause of morbidity and mortality in children under 5 years of age. Molecular identification of circulating wild-type MV) strains is a vital component of the measles elimination program. We received 159 oral swab samples from Afghanistan during 2008-2018. Viral RNA was extracted, followed by one-step RT-PCR and positive amplicons were subject to sequencing for genotype identification. Out of 159 total samples, 52% (83/159) were detected positive by RT-PCR. Genotype D4 was identified from 2.4% (2/83), genotype H1, 4.8% (4/83),and genotype B3, 92.7% (77/83) cases, respectively.

2019–2020 measles in the Republic of Guinea: epidemic features and herd immunity

Introduction. In connection with the Ebola epidemic in the West African countries, including the Republic of Guinea, a failure in implementing measles immunization program was noted. A proportion of measles seronegative subjects in 2017 was 52.4% of total examined individuals. In 2018, a high proportion of measles cases among children aged 1–5 years (61.6%) was identified. In order to stop the 2018 outbreak, the Supplemental Immunization Campaign was conducted in the Konakri and Nzerekore prefectures in the Republic of Guinea. The aim of this study was to examine the 2019–2020 measles epidemic situation and assess the measles population immunity in the Republic of Guinea. Materials and methods. Measles-specific antibodies were examined in 1697 blood serum samples collected from residents of different regions of the Republic of Guinea, aged from 7 months to 76 years, obtained in 2019–2020, and tested retrospectively. The ELISA test systems Anti-Measles Virus ELISA (IgM) Euroimmun and Anti-Measles Virus ELISA (IgG) Euroimmun (Germany) were used. The presence of serum IgM measles antibodies was considered as acute measles infection. Statistical analysis was performed using the software package Statistica 6.0. Results. Blood sera (n = 638) were tested for IgM-measles, and in 46.6% of cases the diagnosis was confirmed by laboratory tests. The biggest proportion of the total cases (61.6%) was found in children aged 1–4 years. The second most important age group was 5–9 years of age, the third is children under 1 year: 18.5% and 11.8% of the total number of patients, respectively. Measles infection was registered in vaccinated patients in 7.4% of the total number of laboratory-confirmed cases. 1059 subjects were examined for IgG measles antibody. The lowest seroprevalence rate was found among children under 4 years of age (47.8%). The highest (85.5%) was found among subjects of 40 years old and older. Conclusion. Measles in GR remains a poorly controlled infection. As in the previous years of observation (2017–2018), children under 5 years of age are the most vulnerable cohort of the population, despite the 2018 DI campaign conducted in a number of GR territories. More problems with the measles control in the Republic of Guinea are expected in the period from 2021, as along with the COVID-19 epidemic, Ebola is repeatedly registered in the country. The Republic of Guinea particularly requires assistance from the international community to implement the WHO measles elimination program on a global scale.

Brote de sarampión en el área sanitaria de Guadalajara (España): dificultad en el diagnóstico microbiológico en la era de su eliminación

IntroductionIn Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tools for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). MethodsSerological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. ResultsA total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in 2 that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or 2 vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. ConclusionsThe combination of molecular tests and the presence of specific IgG and IgM are necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.

Clinical fnd epidemiological features of measles by adults in modern period

Positive results have been achieved during the implementation of the measles elimination program in the Russian Federation and in the Northwestern Federal District (NWFD). However, measles remains an urgent problem for some regions due to the peculiarities of this infection.Purpose of the work: to characterize the clinical, epidemiological and molecular genetic characteristics of measles in adults during the period of increasing incidence in St. Petersburg.Materials and methods: the incidence of measles in the Northwestern Federal District was analyzed in 2006–2020, and the data of 30 patients of S.P. Botkin clinical infectious diseases hospital over 18 years old (2018). The diagnosis of measles is confirmed by enzyme immunoassay. Molecular genetic studies (PCR, sequencing) were carried out at the National Scientific and Methodological Center for the Surveillance of Measles and Rubella of G.N. Gabrichevsky Moscow Scientific Research Institute of Epidemiology and Microbiology, biological material was used (nasopharyngeal washings, urine).Results: there was an increase in morbidity in some regions of the Northwestern Federal District in conditions of high coverage of the population with measles vaccinations. In the age structure in 2018–2019 the proportion of adults was 65%. 74% of patients were not vaccinated against measles. A moderate-severe course (100%) was noted, regardless of the genotypes of the virus. Clinical manifestations were characterized by febrile, catarrhal and exanthema syndrome. Diarrhea was found in 36,7% of patients, hepatomegaly in 43.4%, and an increase in transaminases in 87%. 66,7% of patients traveled outside St. Petersburg. The genotypes of the virus were identified: B3 Kabul and B3 Dublin of African origin, D8 Girsomnath of Indian origin.Conclusions: measles remains an urgent problem, in recent years, adults prevail among patients, both local and imported cases are recorded. The clinical course of the disease may be accompanied by intestinal complications and other symptoms that make it difficult to diagnose at the prehospital stage. The use of molecular genetic methods makes it possible to identify the pathogen, assess the identity of viral isolates, and improve the epidemiological surveillance of the infection.

Comparing humoral immune response in adult measles patients and measles vaccinated subjects

Introduction. The implementation of the WHO Measles Elimination Program has yielded serious results, but in recent years an increase in the incidence rate of this infection has been observed. In particular, according to the WHO, in 2019 vs. 2018 measles morbidity was elevated by 3-fold worldwide. While investigating measles outbreaks among patients, apart from unvaccinated subjects, a substantial group of adults vaccinated in childhood was distinguished. The aim of this work was to examine the characteristics of humoral measles immunity in adult measles patients as well as subjects after measles vaccination. Materials and methods. 50 adult measles patients aged 20 to 55 years were examined. In all patients, the diagnosis was confirmed clinically and by laboratory assays by detecting measles IgM antibodies. The second group consisted of 50 conditionally healthy seronegative age-matched adults, vaccinated with the live measles vaccine (Microgen, Russia). Peripheral blood samples were collected from the cubital vein in total volume of 4 ml on 6±1 day after the onset of rash in patients as well as 6 weeks after vaccination. Specific measles antibodies and their avidity were determined by ELISA using the commercial Avidity: Anti-Measles Viruses ELISA/IgG kit (Euroimmun, Germany). Results. It was shown that people aged 20—35 years more likely suffered from measles than elderly. And it was in this age group that healthy measles seronegative individuals were more abundant. Among vaccinees, 44% responded to vaccination with the primary type of immune response, and 56% responded with the secondary type, while among measles patients, 34% and 66% responded with the primary and secondary type, respectively, as follows from the spectrum of specific IgG subclasses and the antibody avidity assay. The secondary type of immune response indicates that these subjects were apparently vaccinated against measles in childhood, but lost with time long-lived plasma cells producing protective antibodies. While comparing the parameters of specific humoral immunity in groups with acute measles infection (day 6 from the onset of rash) and early convalescents (3 weeks after the onset of rash), it was shown that the level of specific IgG increased threefold in early convalescents (p 0.01) compared with those at acute phase. The level of specific IgA, on the contrary, decreased from 73.44 (69—75.3) Me/ml to 48.64 (45—56.4) Me/ml, but remained very high. At the same time, the spectrum of specific IgG subclasses shifted from primary immune response (high IgG3 and low IgG1) to secondary response (low IgG3 and high IgG1), which is typical for the response of emerging memory B cells.

Level of measles herd immunity assessed in hospital medical workers within a framework of the state measles elimination program

Within a framework of the state measles elimination program, in April, 2018 a level of measles herd immunity was assessed in 1899 Moscow hospital medical workers aged from 19 to 69 years and older. All subjects enrolled in the study were vaccinated against measles or recovered after measles infection. Serum samples were collected from subjects and examined by ELISA for measles IgG antibodies with the Vector-Best IgG-measle test system (Russia). It was found that 278 (14.6%) and 1621 (85.4%) subjects were seronegative ( 0.18 IU/mL) and seropositive ( 0.18 IU/ml), respectively. Age-related group distribution of 1855 serum samples revealed that percentage of seronegative subjects was in: aged 19—23 years was -38.5%; 24-28 and 29-33 years - 22.2%; 34-38 years - 27.5%; 39-43 years - 25.8%; 44-48 years - 16.8%; 49-53 and 54-58 years — 8.6% and 8.3%, respectively; 59-63 years old — 4.9%; 64-68 and over 69 years old — 0%. Moreover, mean level of measles IgG antibodies increased proportionally to age of medical workers from 0.58 IU/ml (19-23 years) to 2.94-2.72 IU/ml (64-68 and over 69 years). The data obtained indicate that a cohort of measles susceptible subjects (from 38.5% to 16.8%), respectively, is identified among young and middle age (from 19 to 48 years) individuals. It is assumed that two-dose measles vaccination in childhood does not contribute to the long-term preservation of protective levels of measles antibodies, thereby justifying a need to administer a three-dose measles vaccine.

Measles Virus Imported by International Traveler in Jiangsu Province of China, in 2018 and 2019.

Measles remains a public health concern in many regions, and the imported measles cases continue to challenge the measles elimination program for most of the countries where measles was verified to be eliminated or approaching elimination. The imported measles cases have been reported since October, 2017, in Jiangsu province, China. In this study, we reported the first imported B3 genotype measles virus from Egypt and the second imported D8 genotype measles virus from Philippines through international traveling. No secondary measles cases were found after these imported cases. Our findings highlighted the importance of measles vaccination targeting international travelers in China.

Implementation of the program of measles elimination in the WHO African region

The review is devoted to the analysis of the available literature on the elimination of measles. The review focuses on the current measles epidemic situation in the African Region (AFR) and the implementation of the WHO strategic plan for the elimination of measles in AFR by 2020. Measles in the AFR is characterized by a severe course with a high risk of death due to malnutrition, vitamin A deficiency, concomitant bacterial and viral infections, and malaria. In 2015, 105,256 cases of measles were reported in the WHO African Region, most of them among children under 5 years old, 79% of whom were not vaccinated or had unknown vaccine status. Initially, the strategy for implementing the measles elimination program in AFRs was based on a combination of immunization campaigns for children under 14 years of age (coverage of more than 90%) and routine vaccination of at least 90% of children aged 9–15 months. It was recommended to repeat the campaign of mass immunization of children aged 9 months up to 4 years every 3–5 years. The use of this strategy has reduced the number of measles cases by 83–97% during the first year of additional immunization programs. The recommended age of routine measles vaccination in AFRs is 9 months — a strategy to reduce infant mortality, including that due to complications of measles. In 2016, measles vaccination was introduced into the national immunization schedule in all AFR countries, and 24 countries introduced revaccination. Currently, the measles elimination program in a number of AFR countries is based on two-dose immunization (MCV1 and MCV2). The measles prevention program in a number of AFR countries was disrupted due to the Ebola epidemic. There are some common problems in the realization of the program in AFR countries. All AFR countries are committed to the measles elimination program. The review provides information on strategies and successes in overcoming challenges to achieve the goals set for the WHO African Region in the implementation of the programme of measles elimination.

Parvirus infection markers in persons with exantemic diseases and in risk groups

Background. In the Russian Federation the number of a parvovirusВ19 infection cases has increased significantly with the introduction of rubella into the measles elimination program and laboratory examination of patients with maculopapular rash and fever. The aim of study was the examination of the distribution of the parvovirusВ19 infection in the North-Western Federal District. Materials and methods. In 2014–2017, 1044 blood sera of patients with exanthema diseases from different territories of the North-Western Federal District have been investigated with «Anti-Parvovirus B19 ELISA IgM» kit (EUROIMMUN, Germany) to detect IgM antibody, and 733 blood sera of clinically healthy men and women 18 to 60 years old have been tested for IgG antibodies using the «Anti-Parvovirus B19 ELISA IgG» kit (EUROIMMUN, Germany). Results. ParvovirusВ19 infection is contentiously detected in 10 of the 11 territories of the district. Typical is the winterspring seasonality; in terms of the age structure – prevalence of children 3–6 (25,3% of cases) and 7–14 (33,3% of cases) years old was detected. A high proportion of seropositivity was established among the examined donors from the higher educational institutions of Saint Petersburg (75,4–88,9%%). Low rate of seropositivity (56,7%) was detected among pregnant women. A high proportion of false negative results in the primary diagnosis of parvovirus infection has been revealed. Conclusion. ParvovirusВ19 infection is widespread in the territories of the North-Western of the Russia, mainly among children. The results indicate the feasibility of conducting a laboratory examination of pregnant women who are contact for exanthemous diseases, for markers of parvovirus infection; on the importance of screening donor blood for PV B19 DNA with “culling” pools characterized by high viral load; on the need for differential laboratory diagnosis between rubella and parvovirus infection.

What will it take to end fatalities from measles?

What will it take to end fatalities from measles?