Measles Virus Circulation Research Articles

Molecular characterization of measles viruses in Central African Republic, 2012-2016.

Despite being preventable through vaccination, measles is still one of the most important causes of morbidity and mortality in young children in Africa. In 2015, several African countries, including the Central African Republic (CAR), began implementing national measles elimination programs. However, measles remains a public health problem in Africa, particularly in the CAR. A retrospective study was conducted at the Institut Pasteur de Bangui, using blood samples (n = 255) and oral swabs (n = 7) collected between January 2012 and December 2016 from measles IgM-positive cases, to attempt genotyping of circulating measles virus strains. Overall, 50 samples were positive by real-time polymerase chain reaction, and 40 sequences of acceptable quality were obtained. The phylogenetic analysis showed that 38 strains belonged to genotype B3 suggesting that this genotype was endemic in the CAR during the study period. No genotype B2 sequences were detected, suggesting that this genotype is no longer present in the CAR.

Genetic Characteristics of Measles Viruses Isolated in Taiwan between 2015 and 2020

A genetic analysis of circulating measles virus (MeV) provides strong evidence of an interruption in endemic measles and supports the elimination status of this disease. This study investigated 219 MeVs isolated between 2015 and 2020. Based on the 450 nucleotide sequences of the nucleoprotein gene (N-450), three genotypes of the H1, D8 and B3 with 8, 18 and 6 different N-450 sequences, respectively, were identified. The H1 genotype virus has not circulated in Taiwan since 2017, and the D8 and B3 genotype MeVs became dominant between 2018 and 2019. Different D8 genotype variants were imported from neighboring countries, and the majority of MeV variants were detected only for a short period. However, MVs/Gir Somnath.IND/42.16[D8], a named strain designated by the World Health Organization (WHO), was detected over 2 years. To explore whether the endemic transmission of measles has been underestimated, another sequence window of the hypervariable, noncoding regions between the matrix (M) and fusion (F) genes (MF-NCR) was introduced to clarify the transmission chain. From the chronological sequence analysis of MeVs with N-450 and MF-NCR sequence windows, no endemic MeV variants lasted over 4 weeks, providing strong evidence to support the contention that Taiwan has reached the status for measles elimination.

Measles, mumps, and rubella vaccination coverage in children younger than 5 years attending a paediatric emergency department in Manchester, UK: a cross-sectional observational study

BackgroundIn 2019, the UK lost its WHO measles-free status, due to circulating measles virus and suboptimal coverage with the measles, mumps, and rubella (MMR) vaccine. The National Health Service (NHS) schedule recommends MMR vaccines at age 12 and 40 months. In England in 2020–21, MMR coverage did not meet the 95% target for herd immunity. This work is part of a project to develop a vaccination intervention delivered in the paediatric emergency department (PED). The aim of this study was to quantify unmet MMR-related vaccination need among PED attendees. MethodsThis cross-sectional, single-centre observational study collected data on children (aged 1–5 years) attending a large district general PED in Greater Manchester, UK, from Oct 1 to Oct 31, 2021, with data collected on a single occasion. Ethics approval was for an opt-out approach. Vaccination data were extracted from individual electronic summary care records, as part of the primary care record visible within secondary care. Coverage in the study population was compared with data for the northwest of England from the Cover of Vaccination Evaluated Rapidly surveillance scheme for the period April 1, 2020 to March 31, 2021. χ2 tests were used to examine differences in proportions vaccinated. Findings1059 children aged 1–5 years attended the PED in October, 2021, and data for 977 children were included in this study. Among all children, 638 (65·3%) had at least one dose of MMR recorded in their summary care record. The most similar regional comparator was first-dose MMR by the age of 5 years, which was administered in 86 678 (95·2%) of 91 023 children in 2020–21 (p<0·0001). In our cohort, among eligible children older than 40 months (n=339), only 66 (19·5%) had received both MMR doses, compared with regional coverage (by age 5 years) in 79 535 (87·4%) of 91 023 children (p<0·0001). A power calculation showed 577 participants were needed to detect a 5% difference in second-dose MMR. InterpretationChildren younger than 5 years attending the PED had low rates of age-appropriate MMR vaccination coverage, suggesting considerable unmet need in these PED attendees. Other work within this project looks at tetanus coverage and sources of vaccination data. FundingNone.

Результати виділення та генотипування вірусів кору, які циркулювали у 2012–2017 роках в Одеській області

Актуальність. Циркуляція різних штамів вірусу кору тісно пов’язана з регіоном та рівнем захворюваності, оскільки циркулюючі штами можуть змінюватись в період епідемічних спалахів та в міжепідемічні періоди. За даними ВООЗ, найбільш поширеним під час епідемічних спалахів у всьому світі є генотип B3. Тому типування циркулюючих штамів вірусу кору, особливо під час епідемічного спалаху, є важливим процесом, у тому числі й з метою прогнозування розвитку епідемії. Метою даного дослідження була ідентифікація та визначення генотипу циркулюючих в Україні штамів вірусу кору в період 2012–2019 років. Матеріали та методи. Була використана та проаналізована звітна документація ДУ «Одеський обласний лабораторний центр» МОЗУ в Одеській області за 2012–2019 роки щодо дослідження матеріалів від хворих з підозрою на кір з використанням молекулярно-біологічних, генетичних, аналітичних та статистичних підходів. Відповідно до стандартного протоколу ВООЗ для секвенування та проведення філогенетичного аналізу від пацієнтів виділяли циркулюючі штами вірусу кору з використанням спеціальної культури клітин Vero/SLAM, а після культивування з отриманого вірус-вміщуючого матеріалу виділяли РНК вірусу кору та проводили ЗТ-ПЛР. Отриману кДНК відправляли на генотипування, яке проводилось у референс-лабораторії ВООЗ з діагностики кору та краснухи в м. Люксембурзі. Результати. За період 2012–2014 років було виділено 20 штамів вірусу кору з 45 проб (сеча та носоглоткові змиви) від хворих з діагнозом «кір». У 2015–2016 роках виділення вірусу не проводилось через одиничні випадки захворювання. У 2017 році було виділено 24 штами вірусу зі 164 проб. Висновки. Отримані в ДУ «Одеський обласний лабораторний центр» результати свідчать, що у міжепідемічний період 2012–2014 років у регіоні циркулював переважно генотип D4, а починаючи з 2017 року, коли спостерігається підвищення кількості захворілих, пов’язане з новим епідемічним спалахом, на півдні України циркулює переважно генотип В3, генетичної лінії MVs/Kabul.AFG/20.2014/3 B3. Як бачимо, ці дані цілком збігаються з даними, наведеними у літературних джерелах, щодо циркуляції генотипів, які зустрічались у певний час в Європейському регіоні залежно від кількості захворілих.

Revealing measles cases in Vietnam during the spread of a new coronavirus infection

Introduction. According to the WHO Strategic Plan, five out of six geographical regions were expected to achieve measles elimination by 2020, among which is the Western Pacific Region (WPR), which includes the Socialist Republic of Vietnam (VNM). In 2019, 14 156 measles cases were detected in Vietnam, which significantly exceeds the level required to achieve its elimination (less than 1 case per 1 million population). Analyzing the causes of the ongoing measles virus circulation in diverse global regions is very important. It is also important to assess a potential impact on the measles incidence due to anti-epidemic measures aimed at combating the COVID-19 pandemic. This research is devoted to revealation measles cases in South Vietnam within the period covering January 2020 to March 2021. Materials and methods. 799 samples of blood sera obtained from different territories of South Vietnam in 2020–2021 were examined for IgM antibodies against measles virus using the Anti-Measles Virus ELISA (IgM) test system (Euroimmun, Germany). The presence of IgM measles virus antibodies in the blood serum was assessed as an acute measles infection. Results. The measles virus was actively circulating in South Vietnam in the first months of 2020. Residents of large cities and industrial centers were mainly involved in the epidemic process. Measles spread mainly among unvaccinated (71.58%) subjects, or who was unaware of vaccinations (25.48%), but also among those who were vaccinated (2.12%) and revaccinated (0.64%). The absolute majority of cases (71%) affected children under the age of three, with a predominance of those at the first year of life. Among the latter, 48% were children aged 7-9 months old. In March- April 2020, there was a sharp decrease in the number of measles cases in South Vietnam, down to a sporadic level (from May 2020 to March 2021). This is probably due to the anti-epidemic measures that were carried out in the VNM in order to limit the spread of COVID-19. Consequently, after the restrictions are lifted, we can expect an increase in the measles incidence in VNM.

Measles virus circulation between the State members of the Indian Ocean Commission?

Background: Despite the availability of safe and effective vaccines, measles resurgence has been observed worldwide in 2018 and 2019. In West Indian Ocean (WIO), almost all islands have reported measles cases during these years. Vaccine coverage was particularly low in Madagascar and Comoros Island, with a single dose provided by the Expanded Program on Immunization. Because of intense exchanges between WIO islands, outbreaks observed in WIO were probably related. Methods and materials: Thanks to the Epidemic Intelligence Unit and the SEGA-One Health network of the Indian Ocean Commission (IOC), composed of five countries (Comoros, Madagascar, Mauritius, France (Reunion), and Seychelles), epidemiological data from each surveillance system were shared. Results: Measles outbreaks have successively occurred in: Mauritius (W12/2018), Madagascar (W35/2018), Reunion (W51/2018) and Comoros (W21/2019; first cases were reported early 2019). As of W41/2019, Madagascar was the most affected island with 244 557 cases (attack rate around 929/100 000) and a case fatality rate of 0,4%. Attack rate was lower in Mauritius (117/100 000) were 1 482 and 4 deaths were reported. In Reunion and Comoros, respectively 96 and 132 cases (of whom 62 were confirmed) were reported; no deaths were reported. Two measles genotypes were circulating in the region: genotype B3 in Madagascar and Comoros; genotype D8 in Mauritius; in Reunion Island both genotypes were observed. Only one case was reported in December 2018 in Seychelles were 2-dose vaccine coverage reached 99% in 2017. Conclusion: Given starting date of each outbreak and circulating genotypes, it can be assumed that outbreaks were closely related, measles virus circulating especially between Mauritius and Reunion on the one hand, and between Madagascar, Comoros and Reunion on the other hand. WIO islands are considered as an epidemiological block where pathogens easily circulate through human and animal exchanges. This situation underlines the importance of the SEGA network which should be further strengthened. For example, development of biological cooperation between WIO islands could help comprehensive epidemiological analyses in the course of outbreaks.

Genetic monitoring of endemic measles virus circulation in European countries

Genetic monitoring of endemic measles virus circulation in European countries

Detection of measles cases in the Republic of Guinea in 2017–2018

In 2017, WHO reported 596 confirmed measles cases in Guinea Republic connected to the 2016–2017 epidemic outbreak that was stopped after additional immunization (SIA) against measles in two provinces of the country. Improving the effectiveness of SIA is associated with the identification of epidemiologically significant groups of the population. The aim of the study was to analyze 2017–2018 measles cases and assess population immunity to measles virus in the Republic of Guinea. Materials and methods. A total of 810 blood serum samples collected from patients with maculo-papular rash and clinical diagnosis “measles?” were tested for measles virus-specific IgM-and IgG antibody level. 445 sera of conditionally healthy individuals aged 7 months to 67 years were examined for anti-measles virus IgG antibody level. Immunoglobulins of classes M and G were detected by ELISA with test systems «Anti-Measles Virus ELISA (IgM)» (Euro immun, Germany) and «Anti-Measles Virus ELISA (IgG)» (Euroimmun, Germany). Results and discussion.In 2017–2018, the epidemic process of the measles in the Republic of Guinea proceeded very intensively, being markedly prevalent in children among age groups. In 2018, more than half of the cases (61.6%) were identified in children aged 1 to 5 years old; the second most abundant age group was children under one year (18.6%), probably due to violated measles vaccination, which in GR are subject to children of nine months of age. It was found that 16.4% of patients (60 out of 366) had documented data on measles vaccination. Potentially, high proportion of measles cases among pre-vaccinated subjects was due to insufficient immune response to a single immunization in children of 9 months of age. Moreover, lowered vaccine-related properties might also be violated “cold chain” during vaccine transportation occurring in tropical climate. Analyzing 445 subjects revealed that total number of measles virus seronegative subjects was 8.3%. However, the vast majority of them were children and young adults aged 7 months to 22 years, where 52.4% of seronegative subjects were identified. Thus, the data obtained indicate that intensive measles virus circulation in human population was continued that necessitate interventions for improving epidemiological surveillance, extend routine measles vaccination coverage and conduct SIAs against measles in GR.

Characteristics of the Epidemiological Situation of Measles in the Period of its Elimination in Republic of Moldova

Relevance Measles continues to be one of the priorities of health care worldwide, due to it high contagiosity, still widespread, severity of the disease and complications. A high degree of population migration contributes to the spread of infection, i.e. global measles virus circulation, clinical change and late diagnosis, inadequate immunization coverage. Aim. Analysis of measles incidence in the Republic of Moldova in 2000–2018. and features of the epidemic process. Materials and Methods. Statistics on measles incidence and immunization coverage in 2000–2018 were used. 340 cases of measles registered in the country in 2018 were subjected to a detailed analysis Results There is a decrease in measles vaccination coverage, in 2017–87.1%. In the same year, the coverage with the first revaccination at 6–7 years was 92.4% and the second at 14–15 years is 94.9%, which is not enough to maintain epidemiological well-being. There are territorial differences in vaccination coverage. In 2018, imported cases of measles were in 62.5% from Ukraine, 25.0% from Russia and 12.5% from Romania. There have been isolated measles cases (14), and epidemic foci or outbreaks (7), with from 2 to 252 cases of measles. The largest measles outbreak in 2018 was registered among those who rest in a religious camp unvaccinated against measles. The average age of the diseased is 14 years, and in outbreaks with a significant number of cases (9 and more) within 7.9–14.9 years. In the age structure of the diseased, children from 1 to 10 years old prevail (66.1%), children under one year old make up 8,2%, teenagers 17,5% and adults 8.2%. Only 11.0% received one dose of measles vaccine, and 3.6% of the relevant age groups received two doses of vaccine. The reason is the refusal of vaccination for religious motive. In 196 (57.6%) cases, the diagnosis was confirmed by laboratory methods, and in the remaining 144 (42.4%) by clinical and epidemiological data. Conclusions Measles remains a childhood infection, but cases of the disease occur among adolescents (17.5%) and adults (8.2%). The uneven of vaccination coverage throughout the country, the low level of responsibility of the population, the increased incidence of measles in neighboring countries, the high level of population migration are risk factors for the importation and spread of measles.

Measles epidemic in Brazil in the post-elimination period: Coordinated response and containment strategies

Purpose: The measles virus circulation was halted in Brazil in 2001 and the country has a routine vaccination coverage against measles, mumps and rubella higher than 95%. In Ceará, the last confirmed case was in 1999. This abstract describes the strategies adopted and the effectiveness of the surveillance and control measures implemented during the epidemic in an attempt to understand the challenges posed by the regional context of post-measles elimination and explain the actions taken to prevent the re-establishment of endemic transmission when the virus is imported. Methods & Materials: A descriptive study was conducted to examine immunization strategies, epidemiological and laboratory surveillance, and communication to contain and halt the chains of measles transmission during an epidemic between December 2013 and October 2015. Results: The epidemic started in December 2013 and lasted 20 months, reaching 38 cities and 1,052 confirmed cases. The D8 genotype was identified. More than 50,000 samples were tested for measles and 86.4% of the confirmed cases had a laboratory diagnosis. The beginning of an campaign vaccination was delayed in part by the availability of vaccine of vaccine. The classic control measures were not enough to control the epidemic. The creation of a committee of experts, the agreement signed between managers of the three spheres of government, the conducting of an institutional active search of suspected cases, vaccination door to door at alternative times, the use of micro planning, a broad advertising campaign at local media and technical operative support contributed to containing the epidemic. Conclusion: It is important to recognize the possibility of epidemics at this stage of post-elimination and prepare a sensitive surveillance system for timely response. The point in the epidemic when the number of cases began to decrease clearly coincided with the point at which the activities of epidemiological surveillance, the immunization sector, coordinated communication actions, laboratory surveillance and primary care were integrated. This coordinated response reduces the chances of spreading the virus and thus the harm and the impact of a measles epidemic

Immunoglobulins and virus antibody titers: of past needs, current requirements, and future options.

Immunoglobulins (Igs) have been in clinical use for almost 70 years, and early on were also used in conjunction with exposure to the measles virus or polio virus. The US regulations that describe functional Ig lot release thus require the demonstration of minimum antibody titers against these two viruses, although the use of vaccines has now dramatically reduced their incidence. The lower clinical importance of these viruses raises the question of whether other virus antibodies might be more informative for patients with immunodeficiency. A literature survey was conducted to identify viruses of potential clinical concern for people with immunodeficiency. The viruses selected have stable seroepidemiology and associated functional antibody assays. As a result, neutralizing antibody titers to human adenovirus 5 (HAdV5), respiratory syncytial virus (RSV) serotypes A and B, and human parainfluenza virus 3 (hPIV3) were determined in Ig lots produced from plasma collected in either the United States or the European Union. The virus antibody titers measured were high and consistent among the Ig lots tested. Use of either US- or EU-derived plasma as starting material resulted in equivalent virus antibody titers, with the exception of RSV serotype B, for which a lower titer was seen in EU plasma-derived Ig lots. With the significant decline in measles virus and polio virus circulation, and even their potential eradication, measurement of antibody titers against other viruses in Ig products may be more informative for functional lot release testing.

1900. Low Prevalence of Protective Antibodies to Measles Among Young Adults in Argentina

BackgroundIn the last years, there has been an increase in incidence of cases of measles in high and middle-income countries. In Argentina, measles elimination was achieved in 2000, with no circulation of measles virus since then; vaccination iscompulsory (two doses MMR vaccine) and coverage is reported to be roughly 85%. The aim of this study was to determine seroprevalence of antibodies to measles in adults, analyzed according to HIV status.MethodsCross-sectional study. All serologic tests requested for measles antibodies in patients aged >18 years between January 2015 and December 2017 in an Infectious Diseases Reference Center in Buenos Aires were retrieved and analyzed according to HIV status and age group. All determinations were done with VIDAS¨ Measles IgG, Biomeriex. Chi-squared and Fisher’s exact tests were used for comparisons.ResultsWe included 2,663 patients with determinations for measles performed in the mentioned period. Of those, 348 were HIV(+), with mean (±SD) age: 34.7(±6.2) years, 85% male (86% MSM), mean (±SD) nadir CD4 (cells/mm3): 369.6(±219.5); 89% VL< 50 copies/mL; and 2,315 were HIV(–), with mean age(±SD): 31(±5.9) years, 67% female. There was a high proportion of seronegative subjects to measles in both groups, but significantly higher in HIV+ patients (40.8% vs. 33.2%; P = 0.005). However, when analyzed by age group, in those <40 years the proportion of seronegativity to measles was higher (HIV+: 45.3% vs. 31.3%, P = 0.02; HIV-: 38.3% vs. 20.2%, P < 0.001; Figure 1). Patients older than 50 years (the most prone to having beenexposed to measles virus) had the highest prevalence of measles antibodies (>92% in both groups; Figure 2); and those younger than 40, the lowest (55% in HIV+ and 62% in HIV−). Stratification by gender did not change any of these findings. In HIV+ persons, seronegativity to measles was not associated with nadir of CD4 < 200 (P = NS). ConclusionWe found a very high proportion of subjects without protective antibodies to measles among those <40 years (higher in HIV+ patients). This is interesting since in Argentina the vast majority of people <40 should have been vaccinated atleast once. Lack of circulation of measles might accelerate waning of antibodies. There might be an increased risk of measles in young people, especially in HIV+ persons; measures to evaluate this situation and eventually (re)vaccinate susceptiblepersons is warranted.Disclosures E. Bissio, MSD: Employee, Salary. M. E. Perez Carrega, MSD: Employee, Salary. J. L. Montes, MSD: Employee, Salary.

Measles in Italy: Viral strains and crossing borders

In 2017, Italy experienced one of the largest outbreaks of measles in recent years, with 5404 notified cases and 4347 confirmed cases. A further 2029 cases were notified during the first 6 months of 2018, and 1516 of them were laboratory-confirmed. The B3 and D8 genotypes were identified as those responsible for the outbreak. Possible transmission routes can be established by monitoring the circulating measles virus strains in support of the national health authorities to warn people and travellers.

Updated NACI recommendations for measles post-exposure prophylaxis.

Human immune globulin (Ig) products are currently recommended as post-exposure prophylaxis (PEP) for measles in certain susceptible groups. However, successful measles vaccination programs in North America have led to low circulation of measles virus and most blood donors now have vaccine-derived immunity. Concurrently, the concentrations of anti-measles antibodies in human Ig products have shown trends of gradual decline and previously recommended doses and routes of administration may no longer be optimally protective. To review the literature and update recommendations on post-exposure prophylaxis for measles, including dosing and route of administration, for measles Ig PEP in susceptible infants and in individuals who are immunocompromised or pregnant, in order to prevent severe disease. The National Advisory Committee on Immunization (NACI) Measles, Mumps, Rubella, Varicella Working Group reviewed key literature, international practices, and product information for current Ig products pertaining to the optimal dosage and routes of Ig administration for measles PEP. It then proposed evidence-based changes to the PEP recommendations that were considered and approved by NACI. NACI continues to recommend that susceptible immunocompetent individuals six months of age and older, who are exposed to measles and who have no contraindications be given measles-mumps-rubella (MMR) vaccine within 72 hours of the exposure. NACI recommends that for susceptible infants younger than six months of age, if injection volume is not a major concern, intramuscular immunoglobulin (IMIg) should be provided at a concentration of 0.5 mL/kg, to a maximum dose of 15 mL administered over multiple injection sites. Susceptible infants six to 12 months old who are identified after 72 hours and within six days of measles exposure should receive IMIg (0.5 mL/kg) if injection volume is not a major concern. For susceptible contacts who are pregnant or immunocompromised, if injection volume is not a concern, IMIg can be provided at a concentration of 0.5 mL/kg understanding that recipients 30 kg or more will not receive the measles antibody concentrations that are considered to be fully protective. Alternatively, in cases where injection volume is a major concern or for recipients 30 kg or more, intravenous immunoglobulin (IVIg) can be provided at a dose of 400 mg/kg.NACI does not recommend that susceptible immunocompetent individuals older than 12 months of age receive Ig PEP for measles exposure due to the low risk of disease complications and the practical challenges of administration for case and contact management. NACI has updated the recommendations for measles PEP to reflect current evidence and best practices in order to prevent severe disease in Canada. Consistent with recommendations in other countries, this includes consideration of off-label use of IVIg in some instances.

Measles epidemic in Brazil in the post-elimination period: Coordinated response and containment strategies

The measles virus circulation was halted in Brazil in 2001 and the country has a routine vaccination coverage against measles, mumps and rubella higher than 95%. In Ceará, the last confirmed case was in 1999. This article describes the strategies adopted and the effectiveness of surveillance and control measures implemented during a measles epidemic in the post-elimination period. The epidemic started in December 2013 and lasted 20 months, reaching 38 cities and 1,052 confirmed cases. The D8 genotype was identified. More than 50,000 samples were tested for measles and 86.4% of the confirmed cases had a laboratory diagnosis. The beginning of an campaign vaccination was delayed in part by the availability of vaccine. The classic control measures were not enough to control the epidemic. The creation of a committee of experts, the agreement signed between managers of the three spheres of government, the conducting of an institutional active search of suspected cases, vaccination door to door at alternative times, the use of micro planning, a broad advertising campaign at local media and technical operative support contributed to containing the epidemic. It is important to recognize the possibility of epidemics at this stage of post-elimination and prepare a sensitive surveillance system for timely response.

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.

Molecular detection and genetic characterization of circulating measles virus in northern Italy

BackgroundLaboratory diagnosis of measles virus (MV) infection and genetic characterization of circulating MV play an essential role in measles surveillance, allowing proper interventions to interrupt endemic transmission. ObjectivesWe describe results obtained using serological and molecular methods to confirm MV infection among suspected cases reported in a large region in the north of Italy during 2010–2014 and the genotyping of the MV strains detected. Study designThree hundred seventy-two samples (361 urine and 11 oral fluids) were tested for MV-RNA detection. In 281 cases, the serological results for MV-IgM detection were also available. ResultsA total of 276 cases were classified as confirmed measles and MV-RNA detection resulted positive for 239/276 cases.Nucleotide sequence analysis revealed sporadic cases of genotypes D9 and different circulations of endemic MV strains (D8, D4 and B3). ConclusionsThis data suggests that there is still an unvaccinated part of the population maintaining the endemic circulation of MV in Italy.

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.

Long-term transmission of measles virus in Central and continental Western Europe.

The World Health Organization (WHO) has adopted an elimination goal for measles and rubella, which is supposed to be met in the WHO European Region (EUR) by 2015. For verification of elimination, it is required that the genotyping data of detected measles viruses provide evidence for the interruption of endemic transmission. In order to record and assess the extent of endemic measles virus (MV) circulation in a part of the EUR, we analyzed transmission chains of the epidemiologically most relevant MV variants identified in Central and continental Western Europe (CCWE) from 2006 to 2013. Based on MV sequence data deposited in the WHO global database for molecular surveillance of measles (MeaNS), the circulation period was calculated for each MV variant at the country-level and for the entire region of CCWE. The MV variants "D5-Okinawa," "D4-Hamburg," "D4-Manchester," and "D8-Frankfurt-Main" spread widely in CCWE; they caused large and long-lasting outbreaks with secondary spread that resulted in additional outbreaks. Nation-wide outbreaks (epidemics) with thousands of measles cases occurred in four countries (Switzerland, France, Bulgaria, and Romania) and were characterized by continuous detection of the same MV variant for more than 12 months suggesting endemic transmission. In the entire region of CCWE, the circulation period of the four predominant MV variants ranged from 18 to 44 months. The long-lasting MV transmission which affected predominantly unvaccinated individuals in different hard-to-reach groups and in the general population is not consistent with the measles elimination goal. Additional efforts are necessary to meet the elimination target in the EUR.

Resurgence of measles in a country of elimination: interim assessment and current control measures in the Republic of Korea in early 2014

Since the beginning of 2014, the Republic of Korea has experienced a resurgence of measles cases. Among the 220 cases confirmed as measles during epidemiological weeks 1-20 (December 29, 2013 to May 17, 2014), 10 imported cases were identified. The predominant genotype was B3, which reflects the circulating measles virus in adjacent countries. Even with the verification of measles elimination in March 2014 by the World Health Organization, recent importation has been related to international travel. Targeted control measures have been implemented in addition to proper isolation and patient care. A vigilant surveillance system and high levels of vaccine coverage should be maintained to sustain the measles elimination status.