Measles Elimination Program Research Articles

Measles in Poland in 2017

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. The aim of the article is to analyze the epidemiological situation of measles in Poland in 2017 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 by the Sanitary and Epidemiological Stations, data from the publications: “Infectious diseases and poisonings in Poland in 2017” and “Vaccinations in Poland in 2017”. In 2017, 63 cases of measles were notified to the surveillance system in Poland (incidence 0,16 per 100 000 population). The highest incidence was observed in the age 5 and was estimated at 1.27 per 100 000 population. Out of all cases, 38 (60.3%) were hospitalized. No fatal cases due to the measles were reported. In 2017 the maintenance of high vaccination coverage among children aged 2 and 12 years old was observed - from 92.9% to 99.3% (primary vaccination, children born in 2010-2016) and from 92.4% to 97.8% (booster vaccination, children born in 2004-2009). The epidemiological situation of measles in 2017 in comparison with the situation in 2016, has improved. Irrespective of that, the vaccination coverage was sustained at the satisfactory level. In order to achieve the improvement of the measles surveillance system, promoting of the measles elimination programme among the physicians is necessary with focusing on the necessity to report and laboratory confirm all measles cases and the cases suspected of measles.

Importance of real-time RT-PCR to supplement the laboratory diagnosis in the measles elimination program in China.

In addition to high vaccination coverage, timely and accurate laboratory confirmation of measles cases is critical to interrupt measles transmission. To evaluate the role of real-time reverse transcription-polymerase chain reaction (RT-PCR) in the diagnosis of measles cases, 46,363 suspected measles cases with rash and 395 suspected measles cases without rash were analyzed in this study; the cases were obtained from the Chinese measles surveillance system (MSS) during 2014–2017 and simultaneously detected by measles-specific IgM enzyme-linked immunosorbent assay (ELISA) and real-time RT-PCR. However, some IgM-negative measles cases were identified by real-time RT-PCR. The proportion of these IgM-negative and viral nucleic acid-positive measles cases was high among measles cases with measles vaccination history, cases without rash symptoms, and cases within 3 days of specimen collection after onset. The proportion of IgM-negative and viral nucleic acid-positive measles cases in the 0–3 day group was up to 14.4% for measles cases with rash and 40% for measles cases without rash. Moreover, the proportions of IgM-negative and nucleic acid-positive measles cases gradually increased with the increase in the measles vaccination dose. Therefore, integrated with IgM ELISA, real-time RT-PCR would greatly improve the accurate diagnosis of measles cases and avoid missing the measles cases, especially for measles cases during the first few days after onset when the patients were highly contagious and for measles cases with secondary vaccine failure. In conclusion, our study reconfirmed that IgM ELISA is the gold-standard detection assay for measles cases confirmation. However, real-time RT-PCR should be introduced and used to supplement the laboratory diagnosis, especially in the setting of pre-elimination and/or elimination wherever appropriate.

Measles in Poland in 2016

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). The aim of the article is to analyze the epidemiological situation of measles in Poland in 2016 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 by the Sanitary and Epidemiological Stations, data from the publications: “Infectious diseases and poisonings in Poland in 2016” and “Vaccinations in Poland in 2016”. In 2016, 133 cases of measles were notified to the surveillance system in Poland (incidence 0,35 per 100 000 population). The highest incidence was observed in the age group 0-4 and was estimated at 4.2 per 100 000 population. Out of all cases, 93 (69.9%) were hospitalized. No fatal cases due to the measles were reported. In 2016 the maintenance of high vaccination coverage among children aged 2 and 11 years old was observed - from 77.4% to 99.4% (primary vaccination, children born in 2009-2015) and from 74.9% to 97.2% (booster vaccination, children born in 2003-2007). The epidemiological situation of measles in 2016 in comparison with the situation in 2015, has deteriorated . Irrespective of that, the vaccination coverage was sustained at the satisfactory level. In order to achieve the improvement of the measles surveillance system, promoting of the measles elimination programme among the physicians is necessary with focusing on the necessity to report and laboratory confirm all measles cases and the cases suspected of measles.

Association between seroprevalence of measles and various social determinants in the year following a measles outbreak in Turkey

ObjectivesDespite an ongoing measles elimination programme, a measles outbreak occurred in 2013 in Turkey. Population-based seroprevalence studies are needed to determine seronegativity and explore the reasons for this outbreak. This study aimed to explore the seroprevalence of measles and its association with various social determinants in a provincial population in Turkey in the year following a measles outbreak. Study designCross-sectional study. MethodsThis study was conducted in Manisa Province in 2014 in a sample of 1740 people aged >2 years. The dependent variable was the seroprevalence of measles. Independent variables were sex, age, migration, household size, household density, income, education level, existence of chronic disease and occupational class. Blood samples were collected from participants at family health centres. The presence of specific measles antibodies in serum samples was determined using an anti-measles virus IgG enzyme-linked immunosorbent assay test. Chi-squared test and logistic regression analysis were performed. ResultsOverall, data from 1250 people were analysed. The seroprevalence of measles in the whole study population was 82.2% (95% confidence interval 80.0–84.2). Seroprevalence was 55.4% among subjects aged 2–9 years, 48.7% among subjects aged 10–19 years, 74.1% among subjects aged 20–29 years and 93.6% among subjects aged 30–39 years (P < 0.01). Seroprevalence in subjects aged >40 years was >95%. The lowest seroprevalence was found in primary school children (40.2%), followed by those below the age for primary education (69.8%) and secondary school graduates (75.1%). The prevalence of measles seronegativity was not associated with any of the social determinants when adjusted for age. ConclusionsThe seroprevalence of measles was lower than expected in the study population and was particularly low in subjects aged <30 years of age despite previous vaccination. Seroprevalence was not associated with social determinants of health that confirmed either an even distribution of virus exposure or fair access to vaccination services. However, the current seroprevalence cannot be sufficiently effective to reach the measles elimination targets, suggesting that it may be necessary to re-evaluate the need for an extra dose of measles vaccine.

The World Health Organization Measles Programmatic Risk Assessment Tool-Romania, 2015.

Despite global improvement in annual measles incidence and mortality since 2000, progress toward elimination goals has slowed. The World Health Organization (WHO) European Region (EUR) established a regional goal for measles and rubella elimination by 2015. Romania is one of 13 EUR countries in which measles remains endemic. To identify barriers to meeting programmatic targets and to aid in prioritizing efforts to strengthen measles elimination strategy implementation, the WHO and U.S. Centers for Disease Control and Prevention developed a measles programmatic risk assessment tool that uses routinely collected data to estimate district-level risk scores. The WHO measles programmatic risk assessment tool was used to identify high-risk areas in order to guide measles elimination program activities in Romania. Of the 42 districts in Romania, 27 (64%) were categorized as very high or high risk. Many of the very-high-risk districts were clustered in the western part of the country or were clustered around the capital Bucharest in the southeastern part of the country. The overall risk scores in the very-high-risk districts were driven primarily by poor surveillance quality and suboptimal population immunity. The measles risk assessment conducted in Romania was the first assessment to be completed in a European country. Annual assessments using the programmatic risk tool could provide valuable information for immunization program and surveillance staff at the national level and in each district to guide activities to enhance measles elimination efforts, such as strengthening routine immunization services, improving immunization campaign planning, and intensifying surveillance.

Monitoring the process of measles elimination by serosurveillance data: The Apulian 2012 study

In 2003 Italy adopted the National Plan for Measles and Congenital Rubella Elimination, but some outbreaks of measles are still occurring, as the target coverage rate (≥95%) for new-borns has currently not been achieved.In order to support the monitoring of the measles elimination programme, the authors carried out a survey about the seroprevalence of measles among Apulia young adults.The study was carried out from May 2011 to June 2012 among blood donors of the Department of Transfusion Medicine of Policlinico General Hospital in Bari. Subjects were enrolled by a convenience sampling. For each enrolled patient we collected a 5mL serum sample. Collected sera were tested by chemiluminescence (CLIA) for anti-Measles IgG.We enrolled 1764 subjects; 1362 (77.2%) were male with a mean age of 38.4±11.7 years. Anti-Measles IgG titre was >16.5UA/mL in 95.1% (95% CI=94.1–96.1) of enrolled subjects with a Geometric Mean Titre (GMT) of 2.3±0.4, which did not differ dividing the enrolled subjects into age groups.As our data showed, the universal routine vaccination changed the epidemiological pattern among adults, in particular young adults (18–24 years), who showed lowest seropositivity rates; in these groups of population there is a risk of the onset of outbreaks due to the presence of susceptible population. This is a paradox linked to the vaccination strategy: when coverage rates keep sub-optimal, measles is more likely to affect young adults and a higher percentage of complications is expected. According to our data, health authorities have to plan a mop-up strategy to actively offer measles vaccination to susceptible young adults.

Real-Time PCR for Measles Virus Detection on Clinical Specimens with Negative IgM Result in Morocco.

Since the confirmation of measles cases represents an important indicator regarding the performance of the measles-elimination program, the aim of this study was to evaluate the effectiveness of the routine procedures followed in Morocco for the laboratory confirmation of measles cases. Suspected cases reported between January 2010 and December 2012 were assessed for the timeliness of the sample collection, occurrence of measles clinical symptoms, and the results of the laboratory diagnoses. For 88% of the 2,708 suspected cases, a clinical specimen was collected within 7d of rash onset, of which 50% were IgM-positive and 2.6% were equivocal. The measles symptoms were reported in 91.4% of the cases; the occurrence of symptoms showed a positive association with the serological results (odds ratio [OR] = 2.9883, 95% confidence interval [CI] 2.2238–4.0157). Of the negative samples, 52% (n = 116) tested positive by real-time polymerase chain reaction (PCR). These results are in favor of using molecular detection to complement serological diagnosis in the context of measles surveillance approach in Morocco. In addition, the introduction of additional laboratory methods for differential diagnosis is required for the final classification of suspected cases with maculopapular rash and fever in the context of the measles elimination program.

An analysis of the incidence of measles in Turkey since 1960.

The aims of this study were to evaluate measles incidence and the effect of elimination strategy interventions on the disease from 1960 to 2014 in Turkey. The administration of measles vaccine started in the rural regions in 1970; it was carried out as a campaign along with the National Vaccine Campaign in 1985, and it has been employed as combined measles, mumps, and rubella under the scope of the Measles Elimination Program (MEP) since 2006 in Turkey. While a dramatic decrease in the reporting of measles was observed between 2000 and 2010, the number of the cases has increased since 2011. The time series of measles incidence was evaluated for possible structural changes with regression models using dummy variables, autocorrelated with error terms. The incidence of measles showed a statistically significant decline between 1985 and 1988 (P = 0.0072) and between 2005 and 2011 (P < 0.0001). However, a statistically significant increase in incidence was noted after 2013 (P = 0.0008). Over the last 54 years, the pattern of measles cases demonstrated a significant decline in incidence. However, the increase in incidence in 2013 should be carefully analyzed and interpreted in terms of the MEP.

Measles Elimination Program in Southern Khorasan-e-Razavi From 2001 to 2011

Based on a 5-year strategy of the Eastern Mediterranean Region since 1999 in the countries that are able to eliminate measles disease, achieving high immunization coverage of over 90% with two doses of MMR, vaccine has been administered in their immunization program that the 1st dose of MMR, immunization coverage doses of vaccine had been administered in over 15 countries and at the 2nd dose over 11 countries were covered over 95% in 2009 [1]. The elimination phase of measles will be achieved when the indigenous transmission of measles is ceased by widespread vaccination in the country. In Khorasan province (before dividing Khorasan to 3 sub-provinces of Northern, Razavi and Southern) 1920 suspected cases were reported to Center of Diseases Control of Iran (CDC) from 2001 to 2005 that suspected cases of neighboring cities of Gonabad and Bajestan cities had the same statues meaning that Ghaenat (Ghaen city) had reported 39 suspected cases from 2001 to 2006 (according to CDC), Torbat-e-Heidariah 169, Ferdows 80 and Kashmar city 79 cases, but 58 cases was reported from Gonabad city at that time. The reported cases across the country had been 122 cases from 2001 2004 [2]. The most important index was detection of 2 suspected cases in 100,000 populations that its incidence was more than 1 and it was 22.5 and 15.4 in 2002 and 2010 in sequence. The incidence of the disease was 7.4 in Birjand, 2.6 in Bojnoord, 4.4 in Mashhad city in 2010 and 6.2 in Sabzevar city in 2007 with the most range of the disease. It seems that one of the most strong points of the program in Gonabad city was low size of its population (in comparing with other cities of Khorasan province) that makes the relationship and interaction easier with other organizations and offices resulted in fast detection and identifying of suspected cases. Considering laboratory results, we found 33 positive cases in Mashhad and 3 in Birjand city in 2010. In 2009 only 5 cases in Mashhad and 7 cases of laboratory positive cases had been recorded in Birjand city in 2007 and 2008. Reporting of detected cases of measles within 48 hours after appearing of cutaneous rashes is from the aims of measles elimination program that in this research the index has been less than 80% before the year 2007, but after that it has increased higher than 90% through improvement of reporting system [3]. In 2006 the index was 57% in Birjand, 75% in Bojnoord, 54% in Mashhad and 48% in Sabzavar city, but it increased gradually in the following years, so that it was 71% in Birjand, 49% in Mashhad, 73% in Sabzevar and 37% (decrease) in Bojnoord city. One of the most important points in the elimination of measles program is to decrease clinically approved cases (sample less) because it decreased from national index in general that Birjand city had 1, Bojnoord 2, Mashhad 26 and Sabzevar city had 5 clinically approved cases in 2010. We conclude that it is necessary to promote and strengthen the system of teaching, informing system and people participation in referring to health centers on time.

Surveillance Plan on Recent Outbreak of Measles and Rubella in Catalonia, Spain

Measles and rubella are two immuno-preventive illnesses. In Catalonia, since 1988 all children are given two doses of measles and rubella vaccine with high levels of vaccination coverage. The measles elimination programme has been carried out since 1990 in Catalonia. This programme includes achieving and keeping high immunization levels among population with high vaccination coverage, intense epidemiological surveillance and an immediate response to the appearance of a case or outbreak. In 2014, the measles incidence rate was 1.9 cases/ 100,000 inhabitants. There were 4 recent outbreaks in 2006, 2011, 2013 and 2014 that affected 381, 289, 31 and 124 people respectively. All outbreaks were triggered by an imported case. In 2011 and 2014 measles outbreaks, 6% and 5.5% of affected people were health care workers. All outbreaks presented a great variety of measles genotypes. Concerning rubella elimination programme, since 2002, 68 cases of postnatal rubella and 5 cases of congenital rubella were confirmed. Regarding measles and rubella surveillance and control, in addition to strengthen vaccination coverage, it is essential immediate notification, within the first 24 hours since suspicion and laboratory confirmation. In addition there is a need to enforce vaccination among health care workers as well as in other susceptible and unvaccinated people. It is recommended to vaccinate all people who were born after 1966 and who have not been vaccinated with two doses of trivalent measles-mumps-rubella vaccine. Furthermore, we have to emphasize that the progress concerning genotypes study allows identifying various imported cases from other European countries with active outbreaks, aspect that makes easier the surveillance of these illnesses.

Genetic characterization of measles virus in the Philippines, 2008-2011.

BackgroundLarge outbreaks of measles occurred in the Philippines in 2010 and 2011. Genetic analysis was performed to identify the genotype of measles virus (MeV) that was responsible for the large outbreaks.MethodsA total of 114 representative MeVs that were detected in the Philippines from 2008 to 2011 were analyzed by sequencing the C-terminal region of nucleocapsid (N) gene and partial hemagglutinin (H) gene and by inferring the phylogenetic trees.ResultsGenetic analysis showed that genotype D9 was the predominant circulating strain during the 4-year study period. Genotype D9 was detected in 23 samples (92%) by N gene sequencing and 93 samples (94%) by H gene analysis. Sporadic cases of genotype G3 MeV were identified in 2 samples (8%) by N gene sequencing and 6 samples (6%) by H gene analysis. Genotype G3 MeV was detected mainly in Panay Island in 2009 and 2010. Molecular clock analysis of N gene showed that the recent genotype D9 viruses that caused the big outbreaks in 2010 and 2011 diverged from a common ancestor in 2005 in one of the neighboring Southeast Asian countries, where D9 was endemic. These big outbreaks of measles resulted in a spillover and were associated with genotype D9 MeV importation to Japan and the USA.ConclusionGenotype D9 MeV became endemic and caused two big outbreaks in the Philippines in 2010 and 2011. Genotype G3 MeV was detected sporadically with limited geographic distribution. This study highlights the importance of genetic analysis not only in helping with the assessment of measles elimination program in the country but also in elucidating the transmission dynamics of measles virus.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1201-1) contains supplementary material, which is available to authorized users.

Implication of health care personnel in measles transmission

Healthcare personnel (HCP) play an important role in transmission of highly contagious diseases such as measles. Current immunization guidelines in Catalonia include Measles-Mumps-Rubella (MMR) immunization for HCP born after 1967 without evidence of immunity. Despite high vaccination coverage (90%) a high burden of measles cases related to outbreaks have occurred. The aim of this study was to assess the implication of HCP in measles transmission related to healthcare setting. A review of surveillance case data from 2001 to 2013 gathered through the Measles Elimination Program in Catalonia was performed. Twenty six outbreaks involving 797 cases were reported, 52 (6.5%) were HCP aged 21–41 years, 72,5% (38) patient were care personnel (doctors and nurses) and 22,5% (14) other health care related personnel. Forty six 87%) were unvaccinated, 4(10%) had only one dose and 2 had two doses of MMR. In community outbreaks 30 clusters with HCP involved were observed, yet none were identified as index cases. Non-vaccinated HCPs against measles were all under 45 years of age. Vaccination is the only reliable protection against nosocomial spread of measles from HCPs. Assessing vaccination status of HCPs and implementing a 2 dose vaccination in those lacking evidence of immunity is needed in order to set to zero the risk of acquiring and spreading measles in healthcare (HC) settings.

An outbreak of adult measles by nosocomial transmission in a high vaccination coverage community

The aims of this study were to determine the mechanism of an outbreak of measles in adults and to provide scientific measures for putting forward a measles elimination program. We performed a cross-sectional investigation during the measles outbreak to identify a possible communication link. From November 1, 2011 to January 26, 2012, the town reported 11 cases of measles in total. The case study identified an obvious propagation chain, which showed ordered and intimate exposure between cases. Hospital exposure 1-2 weeks before infection with measles was the main cause of the measles outbreak. We must be fully aware of the possibility of nosocomial infection in an outbreak of measles; controlling nosocomial infections is a vital step in the prevention and control of the propagation of measles.

Evaluation of 44 pediatric measles cases detected in Ankara, Turkey during 2012-2013 epidemic and molecular characterization of the viruses obtained from two cases

Elimination of measles and rubella until the end of 2015 in parallel with the "World Health Organization (WHO) Europe Region's Measles Elimination" work-up has been targetted and "Measles Elimination Program'' has been carried out since 2002 in Turkey. Due to the routine vaccination programmes the number of the vaccinated children have increased and epidemic incidences have been falling. However, imported measles cases from Europe and other neighboring countries have been observed in Turkey in the recent two years. Patients who applied to Dr. Sami Ulus Maternity and Children's Training and Research Hospital with a pre-diagnosis of measles between December 2012 and April 2013 were screened in this study. Seventy-eight patients who match the clinical definition of the disease (> 38°C fever and maculopapular rash and cough or nasal discharge or conjunctivitis) were evaluated. Forty-four children (25 male, 19 female; age range: 4-191 months, mean age: 58.6 ± 59.5 months) with a positive measles IgM test result were taken into consideration and the epidemiological and clinical features of these children were evaluated. In addition to fever and rash, cough, nasal discharge and conjunctivitis were seen in 36 (82%), 24 (55%), and 18 (41%) patients, respectively. Thirty five (80%) patients were diagnosed in December, 6 (14%) in January, 2 (4%) in February, and 1 (2%) in March. All patients included in the study were unvaccinated or too young to be vaccinated according to the routine vaccination calendar. The index case was a three-year old unvaccinated girl who had a history of contact with the Syrian neighborhoods. During the study period; following contact with the index case, two doctors (born in 1986 with a history of single dose of vaccination at ninth month) and three children (without vaccination) were also diagnosed as measles. Eight (18%) patients were hospitalized because of complications. Four (50%) of them had pneumonia and the other four (50%) had lack of oral feeding and dehydration. Average duration of hospitalization for patients was 4 ± 1.7 (range: 2-6) days and all patients were discharged with full recovery. For molecular typing, viral RNAs were isolated from urine samples of two of the measles IgM positive patients, subjected to sequence analysis of 450 nucleotides comprising the most variable C-terminal region of the nucleoprotein (N) gene. Phylogenetic analysis revealed that those two strains belonged to genotype D8. This study represented the involvement of measles virus genotype D8 in an outbreak in Turkey for the first time. During a measles epidemic, following the index case; medical personnel should be informed about possible, probable, and definite case definitions and should apply for appropriate triage or fast-track (rapidly examination) if necessary, and routine announcements should be made precisely and accurately at proper times and unvaccinated medical personnel and any people in touch with the patient should be vaccinated. In order to reach the elimination goal declared by European WHO for 2015, susceptible populations should be identified and vaccinated in Turkey to obtain sufficient herd immunity for preventing outbreaks.

Implementation of a national measles elimination program in Iran: Phylogenetic analysis of measles virus strains isolated during 2010-2012 outbreaks.

Measles virus (MV) causes small and large outbreaks in Iran. Molecular assays allow identifying and the sources of measles imported from neighboring countries. We carried out a phylogenetic analysis of measles virus circulating in Iran over the period 2010–2012. Specimens from suspected cases of measles were collected from different regions of Iran. Virus isolation was performed on urine and throat swabs. Partial nucleoprotein gene segments of MV were amplified by RT-PCR. PCR products of 173 samples were sequenced and analyzed. The median age of confirmed cases was 2 years. Among all confirmed cases, 32% had unknown vaccination status, 20% had been vaccinated, and 48% had not been vaccinated. Genotypes B3 and D8 (for the first time), H1 and D4 were detected mainly in unvaccinated toddlers and young children. Genotype B3 became predominant in 2012 and was closely related to African strains. H1 strains were also found in small and large outbreaks during 2012 but were not identical to Iranian H1-2009 strains. A majority of the Iranian D4 strains during 2010–2012 outbreaks were linked to the D4 strain identified in the Pakistan in 2007. We identified a single case in 2010 belonging to D8 genotype with 99.7% identity to Indian isolates. Although the vaccination program is currently good enough to prevent nationwide epidemics and successfully decreased measles incidence in Iran, the fraction of protected individuals in the population was not high enough to prevent continuous introduction of cases from abroad. Due to increasing number of susceptible individuals in some areas, sustained transmission of the newly introduced viral genotype remains possible.

Economic analysis of measles elimination program in the Republic of Korea, 2001: A cost benefit analysis study

BackgroundIn this study, we modeled the cost benefit analysis for three different measles vaccination strategies based upon three different measles-containing vaccines in Korea, 2001. We employed an economic analysis model using vaccination coverage data and population-based measles surveillance data, along with available estimates of the costs for the different strategies. In addition, we have included analysis on benefit of reduction of complication by mumps and rubella. MethodsWe evaluated four different strategies: strategy 1, keep-up program with a second dose measles-mumps-rubella (MMR) vaccine at 4–6 years without catch-up campaign; strategy 2, additional catch-up campaign with measles (M) vaccine; strategy 3, catch-up campaign with measles-rubella (MR) vaccine; and strategy 4, catch-up campaign with MMR vaccine. The cost of vaccination included cost for vaccines, vaccination practices and other administrative expenses. The direct benefit of estimated using data from National Health Insurance Company, a government-operated system that reimburses all medical costs spent on designated illness in Korea. ResultsWith the routine one-dose MMR vaccination program, we estimated a baseline of 178,560 measles cases over the 20 years; when the catch-up campaign with M, MR or MMR vaccines was conducted, we estimated the measles cases would decrease to 5936 cases. Among all strategies, the two-dose MMR keep-up program with MR catch-up campaign showed the highest benefit-cost ratio of 1.27 with a net benefit of 51.6 billion KRW. ConclusionAcross different vaccination strategies, our finding suggest that MR catch-up campaign in conjunction with two-dose MMR keep-up program was the most appropriate option in terms of economic costs and public health effects associated with measles elimination strategy in Korea.

Results of the rubella elimination program in Catalonia (Spain), 2002–2011

Rubella is usually a mild disease with nonspecific symptoms, but can cause congenital rubella syndrome (CRS) when infection occurs during pregnancy. The objective of this study was to evaluate the sensitivity and positive predictive value of different data sources used for surveillance purposes in the Rubella Elimination Program of Catalonia between 2002 and 2011. The Urgent Notification to the Statutory Disease Reporting System, the Individualized Disease Reporting System, screening for other viruses included in the Measles Elimination Program, the Microbiological Reporting System and the Minimum Hospital Discharge Data were evaluated. 100 suspected cases of postnatal rubella and 6 suspected cases of CRS were detected. For postnatal rubella, Urgent Notification had the highest sensitivity (32.5%; 95%CI 18.6–49.1), followed by the Virus screening in Measles Elimination Program (25%; 95%CI 12.7-41.2). Virus screening in the Measles Elimination Program had the highest PPV (76.9%; 95%CI 46.1–94.9), followed by the Individualized Disease Reporting System (57.1%; 95%CI 28.9–82.3). For CRS cases, the Individualized Disease Reporting System had the highest sensitivity (100%, 95%CI 29.2–100) and the highest PPV (60%; 95%CI 14.7–100). Most confirmed postnatal cases (25 cases, 48.1%) were in the 25–44 y age group followed by the 15–24 y age group (11 cases, 21.2%). The highest values of sensitivity and PPV for the detection of confirmed cases corresponded to activities that were specifically introduced in the measles and rubella elimination programs.

Reemergence of Measles in South Korea: Implications for Immunization and Surveillance Programs

Following the implementation of the national measles elimination program, the Republic of Korea declared in 2006 that measles had been eliminated. However in 2011, a measles outbreak was reported in Gyeongnam Province in the southeastern part of the country. We conducted active case-based surveillance and analyzed the data of cases reported in 2011 to identify the factors contributing to the reemergence of measles in this province. Of 41 confirmed measles cases reported in Korea, 32 were from within the Gyeongnam Province. Among cases identified in the outbreak, 97% had inadequate history of immunization, 28% were not immunized at the recommended ages, and 22% were infants aged 6-11 months. The outbreak involved transmission in 3 hospitals, 1 kindergarten, 1 day-care center, and 3 households. Molecular analysis of measles virus isolates from 11 cases revealed the same D9 genotype, which was the first to be discovered in Korea. In conclusion, inadequate immunization coverage, non-timely immunization, infants under 12 months of age, nosocomial transmission, and international importation may play important roles in the reemergence of measles in Korea during the attempted sustained elimination of the disease.

Molecular epidemiology of measles virus in Italy, 2002–2007

BackgroundThe European Regional Office of the World Health Organization (WHO/Europe) developed a strategic approach to halt the indigenous transmission of measles in its 53 Member States by 2015. In view of the goal of measles elimination, it is of great importance to assess the circulation of wild-type measles virus (MV). Genetic analysis is indispensable to understand the epidemiology of measles.MethodsUrine and saliva samples were collected between May 2002 and December 2007, in order to find the origins and routes of wild type measles virus circulation. RT-PCR was performed on a total of 414 clinical samples of patients from different Italian regions. The results confirmed the genome presence in 199 samples, out of which 179 were sequenced. The sequences were genotyped by comparing the fragment coding for the carboxyl terminus of the nucleoprotein (450 nucleotides) with that one of the WHO reference strains.ResultsFrom the year 2002 to the year 2007 phylogenetic analysis of measles sequences showed a predominant circulation of the D7 genotype in the Italian territory for the years 2002–2004. This genotype was replaced by D4 and B3 genotypes in the biennium 2006–2007. During the same period C2, A, D5 and D8 genotypes were also detected.ConclusionsGenetic characterization of wild-type MV provides a means to study the transmission pathways of the virus, and is an essential component of laboratory-based surveillance. Knowledge of currently circulating measles virus genotype in Italy will help in monitoring the success of the measles elimination programme and will contribute to evaluate the effectiveness of future vaccination campaigns.

Seroprevalence of measles among children affected by national measles elimination program in Korea, 2010

BackgroundFollowing the implementation of national measles elimination plan in Korea, the elimination was declared in 2006. In order to sustain the elimination, high population immunity should be continuously monitored. To evaluate the current age-related susceptibility within the Korean population, we conducted the seroprevalence in children and adolescents who were affected by the national measles elimination plan. MethodsWe used residual serum specimens to measure measles specific IgG and geometric mean titer (GMT) in birth cohorts 2007–2008 and 1997–2003. Among birth cohorts, 2007–2008 cohorts were grouped to evaluate the timeliness of first dose of MMR, 1994–2003 cohorts were grouped to evaluate the effect of keep-up MMR2 campaign, and 1992–1993 cohorts were grouped to evaluate the effect of catch-up campaign in 2001. ResultsOverall, measles seropositivity rate was 86%. The highest seroprevalence of measles IgG was in birth cohorts 2007–2008. Measles seropositivity declined continuously in age groups. The birth cohorts 1994–1996 showed significantly lower levels of seropositivity and GMT than did the other birth cohorts. ConclusionDespite efforts to eliminate measles for the past 10 years in Korea, our study revealed specific birth cohorts remaining at risk for transmission. The adolescents born during 1994–1996 had the lowest measles seropositivity levels, and might represent a ‘pocket’ that has potential at increased risk for measles transmission. Further discussion for follow-up immunization should be placed for consideration in the near future.