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Jaafar R, Zandotti C, Grimaldier C, Etoundi M, Kadri I, Boschi C, Jardot P, Colson P, Raoult D, La Scola B, Aherfi S. Epidemiological and genetic characterization of measles virus circulating strains at Marseille, France during 2017-2019 measles outbreak. J Infect 2021; 83:361-370. [PMID: 34310945 DOI: 10.1016/j.jinf.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/01/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We attempted to establish a molecular investigation by Next Generation sequencing of the measles virus (MeV) strains circulating in Marseille-France during the last outbreak that occurred between 2017 and 2019. METHODS The circulating MeV were isolated from clinical samples using cell culture method and whole genomes were sequenced by Illumina Miseq Next Generation. Genotyping and comparative analyses were assessed by phylogenetic reconstructions. Clinical and epidemiological data from cases were also recorded. RESULTS A total of 110 MeV strains were isolated in cell culture. Our analysis based on whole genome sequences of 98 isolates confirmed that 93 strains belonged to the genotype D8 and 5 to the genotype B3. Phylogenetic analyses revealed 4 distinct MeV circulating clones in Marseille. Measles mostly occured in children < 5 years-old and in adults 30-50 years-old. Measles infection also occurred in 2 adequately vaccinated cases (2 doses). Among 63 measles cases of whom we had available clinical data informations, a total of 35 patients were hospitalized and 19 developed complications including one death case recorded. CONCLUSIONS Whole Genome Sequencing seems to be a useful tool for more refined genomic characterization of large measles outbreak. Vaccination strategies for measles eradication need to be re-evaluated in the current context.
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Affiliation(s)
- Rita Jaafar
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; MEPHI, Institut de Recherche pour le Développement (IRD), Aix-Marseille Universite, Marseille, France
| | - Christine Zandotti
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Clio Grimaldier
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Maëlia Etoundi
- Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Ines Kadri
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Celine Boschi
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; MEPHI, Institut de Recherche pour le Développement (IRD), Aix-Marseille Universite, Marseille, France; Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Priscilla Jardot
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Philippe Colson
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; MEPHI, Institut de Recherche pour le Développement (IRD), Aix-Marseille Universite, Marseille, France; Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Didier Raoult
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; MEPHI, Institut de Recherche pour le Développement (IRD), Aix-Marseille Universite, Marseille, France; Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Bernard La Scola
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; MEPHI, Institut de Recherche pour le Développement (IRD), Aix-Marseille Universite, Marseille, France; Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France.
| | - Sarah Aherfi
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France; MEPHI, Institut de Recherche pour le Développement (IRD), Aix-Marseille Universite, Marseille, France; Assistance Publique - Hôpitaux de Marseille (AP-HM), Marseille, France.
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2
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Do LP, Van TTT, Nguyen DTM, Van Khang P, Pham QT, Tran MT, Dang AD, Komase K. Epidemiological and molecular characteristics of a measles outbreak in northern Vietnam, 2013-2014. J Clin Virol 2021; 139:104840. [PMID: 33962181 DOI: 10.1016/j.jcv.2021.104840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A nationwide measles outbreak occurred in Vietnam between 2013 and 2014. OBJECTIVES To provide an overview on the 2013-2014 measles outbreak in northern Vietnam using epidemiological and molecular analysis of the measles virus (MeV). STUDY DESIGN Epidemiological information was collected from all suspected cases of measles/rubella. Serum and/or throat swabs were collected for laboratory confirmation of measles. MeV genomes were detected and sequenced for phylogenetic analysis. RESULTS A total of 9577 confirmed measles cases were reported in northern Vietnam with an incidence rate of 116.4/1,000,000 population. Of these, approximately 76.3% had unvaccinated or unknown vaccination history and 55.7% were under five years old. The outbreak started in a minority population from the mountainous area bordering Lao PDR and China and exploded in high-density population areas. Molecular analysis of MeV revealed co-circulation of genotypes H1 and D8, with H1 as the predominant strain, and divided into two clusters: cluster 1, sharing high similarity with those detected in China and Lao PDR, and cluster 2, circulating locally with unidentified origin. The minor D8 strains belonged to the D8-Frankfurt cluster. CONCLUSION The outbreak originated in and spread from a population with limited access to vaccines. Molecular analysis revealed co-circulation of MeVs with three different origins during the outbreak. This is the first report to provide an overview of the 2013-2014 measles outbreak in northern Vietnam, demonstrating the need for vaccination strategies against measles that are tailored to local conditions with enhanced molecular surveillance to achieve measles elimination.
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Affiliation(s)
- Loan Phuong Do
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi 10000, Vietnam.
| | - Trieu Thi Thanh Van
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi 10000, Vietnam
| | - Duyen Thi Mai Nguyen
- Department of Virology, National Institute of Hygiene and Epidemiology, Hanoi 10000, Vietnam
| | - Pham Van Khang
- Department of Communicable Disease Prevention and Control, National Institute of Hygiene and Epidemiology, Hanoi, 10000, Vietnam
| | - Quang Thai Pham
- Department of Communicable Disease Prevention and Control, National Institute of Hygiene and Epidemiology, Hanoi, 10000, Vietnam; Institute of Preventive Medicine and Public health, Hanoi Medical University, Hanoi, 10000, Vietnam
| | - Manh Tung Tran
- Department of Communicable Disease Prevention and Control, National Institute of Hygiene and Epidemiology, Hanoi, 10000, Vietnam
| | - Anh Duc Dang
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, 10000, Vietnam
| | - Katsuhiro Komase
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8640, Japan
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3
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Seki F, Miyoshi M, Ikeda T, Nishijima H, Saikusa M, Itamochi M, Minagawa H, Kurata T, Ootomo R, Kajiwara J, Kato T, Komase K, Tanaka-Taya K, Sunagawa T, Oishi K, Okabe N, Kimura H, Suga S, Kozawa K, Otsuki N, Mori Y, Shirabe K, Takeda M. Nationwide Molecular Epidemiology of Measles Virus in Japan Between 2008 and 2017. Front Microbiol 2019; 10:1470. [PMID: 31333607 PMCID: PMC6620789 DOI: 10.3389/fmicb.2019.01470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Genotyping evidence that supports the interruption of endemic measles virus (MV) transmission is one of the essential criteria to be verified in achieving measles elimination. In Japan since 2014, MV genotype analyses have been performed for most of the measles cases in prefectural public health institutes nationwide. With this strong molecular epidemiological data, Japan was verified to have eliminated measles in March, 2015. However, even in the postelimination era, sporadic cases and small outbreaks of measles have been detected repeatedly in Japan. This study investigated the nationwide molecular epidemiology of MV between 2008 and 2017. The 891 strains in the total period between 2008 and 2017 belonged to seven genotypes (D5, D4, D9, H1, G3, B3, and D8) and 124 different MV sequence variants, based on the 450-nucleotide sequence region of the N gene (N450). The 311 MV strains in the postelimination era between 2015 and 2017 were classified into 1, 7, 8, and 32 different N450 sequence variants in D9, H1, B3, and D8 genotypes, respectively. Analysis of the detection period of the individual N450 sequence variants showed that the majority of MV strains were detected only for a short period. However, MV strains, MVs/Osaka.JPN/29.15/ [D8] and MVi/Hulu Langat.MYS/26.11/ [D8], which are named strains designated by World Health Organization (WHO), have been detected in many cases over 2 or 3 years between 2015 and 2017. The WHO-named strains have circulated worldwide, causing outbreaks in many countries. Epidemiological investigation revealed repeated importation of these WHO-named strains into Japan. To demonstrate the elimination status (interruption of endemic transmission) in situations with repeated importation of the same strains is challenging. Nevertheless, the detailed sequence analysis of individual MV strains and chronological analysis of these strains provided sufficient evidence to show that Japan has still maintained its measles elimination status in 2017.
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Affiliation(s)
- Fumio Seki
- Department of Virology 3, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Tatsuya Ikeda
- Yamagata Prefectural Institute of Public Health, Yamagata, Japan
| | | | - Miwako Saikusa
- Yokohama City Institute of Public Health, Yokohama, Japan
| | | | | | | | - Rei Ootomo
- Tottori Prefectural Institute of Public Health and Environmental Science, Tottori, Japan
| | - Jumboku Kajiwara
- Fukuoka Institute of Health and Environmental Sciences, Dazaifu, Japan
| | - Takashi Kato
- Okinawa Prefectural Institute of Health and Environment, Uruma, Japan
| | - Katsuhiro Komase
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Nobuhiko Okabe
- Kawasaki City Institute for Public Health, Kawasaki, Japan
| | - Hirokazu Kimura
- Graduate School of Health Science, Gunma Paz University, Takasaki, Japan
| | - Shigeru Suga
- Department of Pediatrics, National Mie Hospital, Tsu, Japan
| | - Kunihisa Kozawa
- Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Noriyuki Otsuki
- Department of Virology 3, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshio Mori
- Department of Virology 3, National Institute of Infectious Diseases, Tokyo, Japan
| | - Komei Shirabe
- Yamaguchi Prefectural Institute of Public Health and Environment, Yamaguchi, Japan
| | - Makoto Takeda
- Department of Virology 3, National Institute of Infectious Diseases, Tokyo, Japan
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4
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Gil H, Fernández-García A, Mosquera MM, Hübschen JM, Castellanos AM, de Ory F, Masa-Calles J, Echevarría JE. Measles virus genotype D4 strains with non-standard length M-F non-coding region circulated during the major outbreaks of 2011-2012 in Spain. PLoS One 2018; 13:e0199975. [PMID: 30011283 PMCID: PMC6047782 DOI: 10.1371/journal.pone.0199975] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 06/18/2018] [Indexed: 11/19/2022] Open
Abstract
In recent decades, vaccination has substantially reduced the number of measles cases to levels close to the elimination stage. However, major measles outbreaks occurred in Europe during 2010-2012, after the introduction of the D4-Enfield lineage. We have performed a molecular characterization of 75 measles virus genotype D4 strains from patients infected in Spain between 2004 and 2012 by sequencing the N-450 region and the M-F non-coding region (M-F NCR) in order to identify genetic features of these viruses. The analysis of the N-450 region confirmed that all samples obtained since 2008 belonged to variants or sets of identical sequences of the D4-Enfield lineage, including a new one named MVs/Madrid.ESP/46.10/. Analysis of the M-F NCR showed insertions and deletions associated with previously described, uncommon non-standard genome length measles viruses. This genetic feature was identified in the D4-Enfield lineage viruses, but not in the other D4 viruses that were circulating in Spain before 2008, suggesting that these non-standard length M-F NCR sequences are characteristic of the D4-Enfield lineage. The results of the phylogenetic analysis of Spanish M-F NCRs suggest higher resolution in discriminating strains than did the N-450 analysis. In addition, the results of the analysis of the M-F NCR on the MVs/Madrid.ESP/46.10/ sub-lineage seem to support the potential utility of this region as a tool for epidemiological surveillance complementary to the N-450 region, as previously suggested. Further investigation on this question, as well as the surveillance of new potentially emerging strains with non-standard length M-F NCR are strongly recommended as part of future strategies for measles elimination.
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Affiliation(s)
- Horacio Gil
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Aurora Fernández-García
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- * E-mail:
| | - María Mar Mosquera
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Judith M. Hübschen
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Ana M. Castellanos
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Fernando de Ory
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Josefa Masa-Calles
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan E. Echevarría
- National Reference Laboratory for Measles and Rubella, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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5
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Höcker B, Aguilar M, Schnitzler P, Pape L, Dello Strologo L, Webb NJA, Bald M, Genc G, Billing H, König J, Büscher A, Kemper MJ, Marks SD, Pohl M, Wigger M, Topaloglu R, Rieger S, Krupka K, Bruckner T, Fichtner A, Tönshoff B. Incomplete vaccination coverage in European children with end-stage kidney disease prior to renal transplantation. Pediatr Nephrol 2018; 33:341-350. [PMID: 28983694 DOI: 10.1007/s00467-017-3776-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/11/2017] [Accepted: 07/17/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Because infections constitute a major cause of morbidity and mortality in paediatric renal allograft recipients, avoidance of preventable systemic infections by vaccination before transplantation is of utmost importance. However, data on the completeness of vaccinations and factors associated with incomplete vaccination coverage are scarce. METHODS Within the framework of the Cooperative European Paediatric Renal Transplant Initiative (CERTAIN), we therefore performed a multi-centre, multi-national, retrospective study investigating the vaccination coverage before transplantation of 254 European children with end-stage renal disease (mean age 10.0 ± 5.6 years). RESULTS Only 22 out of 254 patients (8.7%) presented complete vaccination coverage. In particular, the respective vaccination coverage against human papillomavirus (27.3%), pneumococci (42.0%), and meningococci (47.9%) was low. Patients with complete pneumococcal vaccination coverage had numerically less lower respiratory tract infections during the first 3 years post-transplant than children without vaccination or with an incomplete status (16.4% vs 27.7%, p = 0.081). Vaccine-preventable diseases post-transplant were 4.0 times more frequently in unvaccinated than in vaccinated patients. Factors associated with an incomplete vaccination coverage were non-Caucasian ethnicity (OR 9.21, p = 0.004), chronic dialysis treatment before transplantation (OR 6.18, p = 0.001), and older age at transplantation (OR 1.33, p < 0.001). CONCLUSIONS The vaccination coverage in paediatric kidney transplant candidates is incomplete. Paediatric nephrologists, together with primary-care staff and patients' families, should therefore make every effort to improve vaccination rates before kidney transplantation.
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Affiliation(s)
- Britta Höcker
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Martin Aguilar
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, University Hospital Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Lars Pape
- Hanover Medical School, Carl-Neuberg-Strasse 1, 30625, Hanover, Germany
| | - Luca Dello Strologo
- IRCCS Ospedale Pediatrico Bambino Gesù, Piazza di Sant'Onofrio 4, 00165, Rome, Italy
| | - Nicholas J A Webb
- Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, M13 9WL, Manchester, UK
| | - Martin Bald
- Clinic of Stuttgart, Olga Children's Hospital, Kriegsbergstrasse 62, 70174, Stuttgart, Germany
| | - Gurkan Genc
- Paediatric Nephrology Department, Ondokuz Mayis University Faculty of Medicine, Children's Hospital, Kurupelit, 55139, Samsun, Turkey
| | - Heiko Billing
- University Children's Hospital, Hoppe-Seyler-Strasse 1, 72076, Tübingen, Germany
| | - Jens König
- Department of General Paediatrics, Paediatric Nephrology, University Children's Hospital, Waldeyerstrasse 22, 48149, Münster, Germany
| | - Anja Büscher
- University Children's Hospital, Hufelandstrasse 55, 45122, Essen, Germany
| | - Markus J Kemper
- University Children's Hospital, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital, Great Ormond Street Hospital for Children NHS Foundation Trust, WC1N 3JH, London, UK
| | - Martin Pohl
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center, Faculty of Medicine, University of Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany
| | - Marianne Wigger
- Paediatric Nephrology, University Children's Hospital, Ernst-Heydemann-Strasse 8, 18057, Rostock, Germany
| | - Rezan Topaloglu
- Department of Paediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Susanne Rieger
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Kai Krupka
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Alexander Fichtner
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Paediatrics I, University Children's Hospital, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
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6
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de Swart RL, de Vries RD, Rennick LJ, van Amerongen G, McQuaid S, Verburgh RJ, Yüksel S, de Jong A, Lemon K, Nguyen DT, Ludlow M, Osterhaus ADME, Duprex WP. Needle-free delivery of measles virus vaccine to the lower respiratory tract of non-human primates elicits optimal immunity and protection. NPJ Vaccines 2017; 2:22. [PMID: 29263877 PMCID: PMC5627256 DOI: 10.1038/s41541-017-0022-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/26/2017] [Accepted: 06/08/2017] [Indexed: 11/09/2022] Open
Abstract
Needle-free measles virus vaccination by aerosol inhalation has many potential benefits. The current standard route of vaccination is subcutaneous injection, whereas measles virus is an airborne pathogen. However, the target cells that support replication of live-attenuated measles virus vaccines in the respiratory tract are largely unknown. The aims of this study were to assess the in vivo tropism of live-attenuated measles virus and determine whether respiratory measles virus vaccination should target the upper or lower respiratory tract. Four groups of twelve cynomolgus macaques were immunized with 104 TCID50 of recombinant measles virus vaccine strain Edmonston-Zagreb expressing enhanced green fluorescent protein. The vaccine virus was grown in MRC-5 cells and formulated with identical stabilizers and excipients as used in the commercial MVEZ vaccine produced by the Serum Institute of India. Animals were immunized by hypodermic injection, intra-tracheal inoculation, intra-nasal instillation, or aerosol inhalation. In each group six animals were euthanized at early time points post-vaccination, whereas the other six were followed for 14 months to assess immunogenicity and protection from challenge infection with wild-type measles virus. At early time-points, enhanced green fluorescent protein-positive measles virus-infected cells were detected locally in the muscle, nasal tissues, lungs, and draining lymph nodes. Systemic vaccine virus replication and viremia were virtually absent. Infected macrophages, dendritic cells and tissue-resident lymphocytes predominated. Exclusive delivery of vaccine virus to the lower respiratory tract resulted in highest immunogenicity and protection. This study sheds light on the tropism of a live-attenuated measles virus vaccine and identifies the alveolar spaces as the optimal site for respiratory delivery of measles virus vaccine.
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Affiliation(s)
- Rik L de Swart
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Rory D de Vries
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Linda J Rennick
- Department of Microbiology, Boston University School of Medicine, Boston, MA USA
| | - Geert van Amerongen
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.,Viroclinics Biosciences, Rotterdam, Netherlands
| | | | - R Joyce Verburgh
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.,Present Address: ProQR Therapeutics, Leiden, Netherlands
| | - Selma Yüksel
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Alwin de Jong
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Ken Lemon
- Queen's University of Belfast, Belfast, Northern Ireland UK.,Present Address: Agri-Food and Biosciences Institute, Belfast, UK
| | - D Tien Nguyen
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Martin Ludlow
- Department of Microbiology, Boston University School of Medicine, Boston, MA USA.,Present Address: University of Veterinary Medicine Hannover, Hannover, Germany
| | - Albert D M E Osterhaus
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.,Present Address: University of Veterinary Medicine Hannover, Hannover, Germany
| | - W Paul Duprex
- Department of Microbiology, Boston University School of Medicine, Boston, MA USA
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7
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Santibanez S, Hübschen JM, Ben Mamou MC, Muscat M, Brown KE, Myers R, Donoso Mantke O, Zeichhardt H, Brockmann D, Shulga SV, Muller CP, O'Connor PM, Mulders MN, Mankertz A. Molecular surveillance of measles and rubella in the WHO European Region: new challenges in the elimination phase. Clin Microbiol Infect 2017; 23:516-523. [PMID: 28712666 DOI: 10.1016/j.cmi.2017.06.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The WHO European Region (EUR) has adopted the goal of eliminating measles and rubella but individual countries perform differently in achieving this goal. Measles virus spread across the EUR by mobile groups has recently led to large outbreaks in the insufficiently vaccinated resident population. As an instrument for monitoring the elimination process and verifying the interruption of endemic virus transmission, molecular surveillance has to provide valid and representative data. Irrespective of the country's specific situation, it is required to ensure the functionality of the laboratory surveillance that is supported by the WHO Global Measles and Rubella Laboratory Network. AIMS To investigate whether the molecular surveillance in the EUR is adequate for the challenges in the elimination phase, we addressed the quality assurance of molecular data, the continuity and intensity of molecular monitoring, and the analysis of transmission chains. SOURCES Published articles, the molecular External Quality Assessment Programme of the WHO, the Centralized Information System for Infectious Diseases of the WHO EUR and the WHO Measles and Rubella Nucleotide Surveillance databases served as information sources. CONTENT Molecular proficiency testing conducted by the WHO in 2016 has shown that the expertise for measles and rubella virus genotyping exists in all parts of the EUR. The analysis of surveillance data reported nationally to the WHO in 2013-2016 has revealed some countries with outbreaks but not sufficiently representative molecular data. Long-lasting supranational MV transmission chains were identified. IMPLICATIONS A more systematic molecular monitoring and recording of the transmission pattern for the whole EUR could help to create a meaningful picture of the elimination process.
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Affiliation(s)
- S Santibanez
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch-Institut, Berlin, Germany.
| | - J M Hübschen
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - M C Ben Mamou
- Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - M Muscat
- Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - K E Brown
- WHO Global Specialized Laboratory for Measles and Rubella, Virus Reference Department, Public Health England, London, UK
| | - R Myers
- WHO Global Specialized Laboratory for Measles and Rubella, Virus Reference Department, Public Health England, London, UK
| | - O Donoso Mantke
- INSTAND e.V. - Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V., Düsseldorf, Germany
| | - H Zeichhardt
- INSTAND e.V. - Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien e.V., Düsseldorf, Germany; Institut für Virologie, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany; Institut für Qualitätssicherung in der Virusdiagnostik - IQVD, Berlin, Germany
| | - D Brockmann
- Epidemiological Modelling of Infectious Diseases, Robert Koch-Institut, Berlin, Germany; Institute for Theoretical Biology, Department of Biology, Humboldt University of Berlin, Berlin, Germany
| | - S V Shulga
- WHO European Regional Reference Laboratory for Measles and Rubella, Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - C P Muller
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - P M O'Connor
- Vaccine-preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - M N Mulders
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - A Mankertz
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch-Institut, Berlin, Germany
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8
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Kriss JL, Stanescu A, Pistol A, Butu C, Goodson JL. The World Health Organization Measles Programmatic Risk Assessment Tool-Romania, 2015. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:1096-1107. [PMID: 27439071 PMCID: PMC9245689 DOI: 10.1111/risa.12669] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/04/2016] [Indexed: 05/30/2023]
Abstract
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.
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Affiliation(s)
- Jennifer L. Kriss
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aurora Stanescu
- National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, Bucharest, Romania
| | - Adriana Pistol
- National Institute of Public Health, National Centre for Communicable Diseases Surveillance and Control, Bucharest, Romania
| | - Cassandra Butu
- World Health Organization Country Office, Bucharest, Romania
| | - James L. Goodson
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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9
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Magurano F, Baggieri M, Filia A, Del Manso M, Lazzarotto T, Amendola A, D'Agaro P, Chironna M, Ansaldi F, Iannazzo S, Bucci P, Marchi A, Nicoletti L. Towards measles elimination in Italy: Virological surveillance and genotypes trend (2013-2015). Virus Res 2017; 236:24-29. [PMID: 28522332 DOI: 10.1016/j.virusres.2017.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/10/2017] [Accepted: 05/12/2017] [Indexed: 11/25/2022]
Abstract
In accordance with the goal of the World Health Organization Regional Office for Europe, the Italian National Measles and Rubella Elimination Plan aimed to interrupt indigenous measles transmission in Italy by the end of 2015. However, from 2013 to 2015, Italy experienced high measles burden with 4902 measles cases (49.3% laboratory-confirmed) reported to the enhanced measles surveillance system (cumulative incidence in the triennium reference period: 2.4/100,000 population). The measles elimination goal was not reached. Laboratory surveillance of measles circulating genotypes is performed by the Measles and Rubella National Reference Laboratory (NRL) at the Italian National Institute of Health (Istituto Superiore di Sanità - ISS), in Rome. Samples received from 1 January 2013-31 December 2015 were analysed. Those positive for measles genome by molecular tests were sequenced and phylogenetically analysed. Phylogenetic analysis performed by NRL identified that genotypes D4 and D8 were endemic and co-circulated in 2011-2013: study results show that genotype D4 disappeared during 2013. Sporadic cases were associated to genotype B3 during 2011-2013, which became endemic in Italy during 2014 and co-circulated with D8 until 2015. Sporadic cases were found belonging to genotypes D9 and H1 all over the period in exam. Similar trend has been observed in European WHO Region.
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Affiliation(s)
- Fabio Magurano
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Melissa Baggieri
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Antonietta Filia
- Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Martina Del Manso
- Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Tiziana Lazzarotto
- DIMES, Operative Unit of Clinical Microbiology, Laboratory of Virology St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy.
| | - Antonella Amendola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Pierlanfranco D'Agaro
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy; Institute for Maternal and Child Health-IRCCS "Burlo". Garofolo", Trieste, Italy.
| | - Maria Chironna
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy.
| | | | - Stefania Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy.
| | - Paola Bucci
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Antonella Marchi
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
| | - Loredana Nicoletti
- National Reference Laboratory for Measles and Rubella, Department of Infectious Diseases, National Institute of Health, Rome, Italy.
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10
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Antigenic Drift Defines a New D4 Subgenotype of Measles Virus. J Virol 2017; 91:JVI.00209-17. [PMID: 28356529 DOI: 10.1128/jvi.00209-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/19/2017] [Indexed: 01/25/2023] Open
Abstract
The measles virus hemagglutinin (MeV-H) protein is the main target of protective neutralizing antibodies. Using a panel of monoclonal antibodies (MAbs) that recognize known major antigenic sites in MeV-H, we identified a D4 genotype variant that escapes neutralization by MAbs targeting the neutralizing epitope (NE) antigenic site. By site-directed mutagenesis, L249P was identified as the critical mutation disrupting the NE in this genotype D4 variant. Forty-two available D4 genotype gene sequences were subsequently analyzed and divided into 2 groups according to the presence or absence of the L249P MeV-H mutation. Further analysis of the MeV-N gene sequences of these 2 groups confirmed that they represent clearly definable, sequence-divergent D4 subgenotypes, which we named subgenotypes D4.1 and D4.2. The subgenotype D4.1 MeVs were isolated predominantly in Kenya and Ethiopia, whereas the MAb-resistant subgenotype D4.2 MeVs were isolated predominantly in France and Great Britain, countries with higher vaccine coverage rates. Interestingly, D4.2 subgenotype viruses showed a trend toward diminished susceptibility to neutralization by human sera pooled from approximately 60 to 80 North American donors. Escape from MAb neutralization may be a powerful epidemiological surveillance tool to monitor the evolution of new MeV subgenotypes.IMPORTANCE Measles virus is a paradigmatic RNA virus, as the antigenic composition of the vaccination has not needed to be updated since its discovery. The vaccine confers protection by inducing neutralizing antibodies that interfere with the function of the hemagglutinin protein. Viral strains are indistinguishable serologically, although characteristic nucleotide sequences differentiate 24 genotypes. In this work, we describe a distant evolutionary branch within genotype D4. Designated subgenotype D4.2, this virus is distinguishable by neutralization with vaccine-induced monoclonal antibodies that target the neutralizing epitope (NE). The subgenotype D4.2 viruses have a higher predominance in countries with intermediary levels of vaccine coverage. Our studies demonstrate that subgenotype D4.2 lacks epitopes associated with half of the known antigenic sites, which significantly impacts our understanding of measles virus evolution.
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11
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Hübschen JM, Bork SM, Brown KE, Mankertz A, Santibanez S, Ben Mamou M, Mulders MN, Muller CP. Challenges of measles and rubella laboratory diagnostic in the era of elimination. Clin Microbiol Infect 2017; 23:511-515. [PMID: 28412379 DOI: 10.1016/j.cmi.2017.04.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 11/26/2022]
Abstract
The Member States of the WHO European Region adopted the goal of measles and rubella elimination more than 10 years ago, but so far only 21 of 53 countries have reached this target. Laboratory investigation of suspected cases is essential to support disease elimination efforts. Therefore, WHO maintains a network of accredited laboratories providing high-quality testing. Laboratory investigation heavily relies on specific IgM serology and increasingly on virus detection by reverse transcription (RT)-PCR, but other methods such as IgG avidity testing and genetic characterization of virus strains have gained in importance. In elimination settings, often few samples from suspected cases are available for testing, but testing proficiency must be maintained. The predictive value of an IgM-positive result decreases and other rash-fever disease aetiologies become more important. In addition, cases with a rash after measles/rubella vaccination or with mild disease after waning of vaccine-induced antibodies are seen more often. Thus, it is necessary to perform comprehensive and potentially time-consuming and costly investigations of every suspected case using quality-controlled laboratory methods. At the same time rapid feedback to public health officers is required for timely interventions. The introduction of new laboratory methods for comprehensive case investigations requires training of staff under the supervision of WHO-accredited reference laboratories and the definition of appropriate test algorithms. Clinical, laboratory, and epidemiological data are essential for final case classification and investigation of chains of transmission in the endgame of measles and rubella elimination.
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Affiliation(s)
- J M Hübschen
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - S M Bork
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg
| | - K E Brown
- WHO Global Specialized Laboratory for Measles and Rubella, Virus Reference Department, Public Health England, London, UK
| | - A Mankertz
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch Institute, Berlin, Germany
| | - S Santibanez
- WHO European Regional Reference Laboratory for Measles and Rubella, Robert Koch Institute, Berlin, Germany
| | - M Ben Mamou
- Vaccine-Preventable Diseases and Immunization, WHO Regional Office for Europe, Copenhagen, Denmark
| | - M N Mulders
- Expanded Programme on Immunization, Department of Immunization, Vaccines, and Biologicals, WHO, Geneva, Switzerland
| | - C P Muller
- WHO European Regional Reference Laboratory for Measles and Rubella, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette and Laboratoire National de Santé, Dudelange, Luxembourg.
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12
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Measles re-emergence in Northern Italy: Pathways of measles virus genotype D8, 2013-2014. INFECTION GENETICS AND EVOLUTION 2016; 48:120-126. [PMID: 27989661 DOI: 10.1016/j.meegid.2016.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 12/02/2016] [Accepted: 12/13/2016] [Indexed: 11/22/2022]
Abstract
Molecular surveillance and advanced phylogenetic methods are important tools to track the pathways of Measles virus (MV) genotypes, provide evidence for the interruption of endemic transmission and verify the elimination of the disease. The aims of this study were to describe the genetic profile of MV genotype D8 (D8-MV) strains circulating in Northern Italy (Lombardy Region) during the 2013-2014 period and to analyze the transmission chains and estimate the introduction time points using a phylogenetic approach. Forty-four strains of D8-MV identified from 12 outbreaks and 28 cases reported as sporadic were analyzed. Molecular analysis was performed by sequencing the highly variable 450nt region of the N gene of MV genome (N-450), as recommended by the WHO. Phylogenetic analyses and tree time-scaled reconstruction were performed with BEAST software. We could trace back the transmission pathways that resulted in three chains of transmission, two introductions with limited spread (two familiar outbreaks), and two single introductions (true sporadic cases). The D8-Taunton transmission chain, which was involved in 7 outbreaks and 13 sporadic cases, was endemic during the studied period. Furthermore, two novel local variants emerged independently in March 2014 and caused two transmission chains linked to at least 3 outbreaks. Overall, viral diversity was high and strains belonging to 5 different variants were identified. The results of this study clearly demonstrate that multiple lineages of D8-MV co-circulated in Northern Italy. Measles can be considered a re-emerging disease in Italy and additional efforts are necessary to achieve measles elimination goal.
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13
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Measles, mumps, rubella and VZV: importance of serological testing of vaccine-preventable diseases in young adults living with HIV in Germany. Epidemiol Infect 2016; 145:236-244. [PMID: 27780480 DOI: 10.1017/s095026881600217x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Measles, mumps, rubella (MMR) and varicella zoster virus (VZV) infection can cause serious diseases and complications in the HIV-positive population. Due to successful vaccination programmes measles, mumps and congenital rubella syndrome has become neglected in Germany. However, recent outbreaks of measles have occurred from import-associated cases. In this cross-sectional study the serostatus for MMR and VZV in 2013 HIV-positive adults from three different university outpatient clinics in Bonn (n = 544), Cologne (n = 995) and Munich (n = 474) was analysed. Sera were tested for MMR- and VZV-specific immunglobulin G antibodies using commercial immunoassays. Seronegativity was found in 3% for measles, 26% for mumps, 11% for rubella and 2% for VZV. Regarding MMR, 35% of patients lacked seropositivity against at least one infectious agent. In multivariable analysis younger age was strongly associated with seronegativity against all four viruses, measles, mumps, rubella (P < 0·001, P < 0·001 and P = 0·001, respectively) and VZV (P = 0·001). In conclusion, there is high need for MMR and VZV vaccination in people living with HIV in Germany born in 1970 or later. Thus, systematic MMR and VZV antibody screening and vaccination should be implemented in the HIV-positive population to prevent serious disease and complications of vaccine-preventable diseases.
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14
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Abstract
Measles is an infectious disease in humans caused by the measles virus (MeV). Before the introduction of an effective measles vaccine, virtually everyone experienced measles during childhood. Symptoms of measles include fever and maculopapular skin rash accompanied by cough, coryza and/or conjunctivitis. MeV causes immunosuppression, and severe sequelae of measles include pneumonia, gastroenteritis, blindness, measles inclusion body encephalitis and subacute sclerosing panencephalitis. Case confirmation depends on clinical presentation and results of laboratory tests, including the detection of anti-MeV IgM antibodies and/or viral RNA. All current measles vaccines contain a live attenuated strain of MeV, and great progress has been made to increase global vaccination coverage to drive down the incidence of measles. However, endemic transmission continues in many parts of the world. Measles remains a considerable cause of childhood mortality worldwide, with estimates that >100,000 fatal cases occur each year. Case fatality ratio estimates vary from <0.01% in industrialized countries to >5% in developing countries. All six WHO regions have set goals to eliminate endemic transmission of MeV by achieving and maintaining high levels of vaccination coverage accompanied by a sensitive surveillance system. Because of the availability of a highly effective and relatively inexpensive vaccine, the monotypic nature of the virus and the lack of an animal reservoir, measles is considered a candidate for eradication.
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15
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Holzmann H, Hengel H, Tenbusch M, Doerr HW. Eradication of measles: remaining challenges. Med Microbiol Immunol 2016; 205:201-8. [PMID: 26935826 PMCID: PMC4866980 DOI: 10.1007/s00430-016-0451-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/11/2016] [Indexed: 12/11/2022]
Abstract
Measles virus (MeV) is an aerosol-borne and one of the most contagious pathogenic viruses known. Almost every MeV infection becomes clinically manifest and can lead to serious and even fatal complications, especially under conditions of malnutrition in developing countries, where still 115,000 to 160,000 patients die from measles every year. There is no specific antiviral treatment. In addition, MeV infections cause long-lasting memory B and T cell impairment, predisposing people susceptible to opportunistic infections for years. A rare, but fatal long-term consequence of measles is subacute sclerosing panencephalitis. Fifteen years ago (2001), WHO has launched a programme to eliminate measles by a worldwide vaccination strategy. This is promising, because MeV is a human-specific morbillivirus (i.e. without relevant animal reservoir), safe and potent vaccine viruses are sufficiently produced since decades for common application, and millions of vaccine doses have been used globally without any indications of safety and efficacy issues. Though the prevalence of wild-type MeV infection has decreased by >90 % in Europe, measles is still not eliminated and has even re-emerged with recurrent outbreaks in developed countries, in which effective vaccination programmes had been installed for decades. Here, we discuss the crucial factors for a worldwide elimination of MeV: (1) efficacy of current vaccines, (2) the extremely high contagiosity of MeV demanding a >95 % vaccination rate based on two doses to avoid primary vaccine failure as well as the installation of catch-up vaccination programmes to fill immunity gaps and to achieve herd immunity, (3) the implications of sporadic cases of secondary vaccine failure, (4) organisation, acceptance and drawbacks of modern vaccination campaigns, (5) waning public attention to measles, but increasing concerns from vaccine-associated adverse reactions in societies with high socio-economic standards and (6) clinical, epidemiological and virological surveillance by the use of modern laboratory diagnostics and reporting systems. By consequent implementation of carefully designed epidemiologic and prophylactic measures, it should be possible to eradicate MeV globally out of mankind, as the closely related morbillivirus of rinderpest could be successfully eliminated out of the cattle on a global scale.
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Affiliation(s)
| | - Hartmut Hengel
- />Institute of Virology, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Matthias Tenbusch
- />Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - H. W. Doerr
- />Institute for Medical Virology, Goethe-University Hospital Frankfurt, Frankfurt/M., Germany
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16
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Kalaycioglu AT, Yolbakan S, Guldemir D, Korukluoglu G, Coskun A, Cosgun Y, Durmaz R. Towards measles elimination: Phylogenetic analysis of measles viruses in Turkey (2012-2013) and identification of genotype D8. J Med Virol 2016; 88:1867-73. [PMID: 27089242 DOI: 10.1002/jmv.24548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 12/21/2022]
Abstract
Molecular characterization of different measles virus (MV) strains is essential to combat the disease. Sixty measles MV strains were obtained from throat swabs or urine of patients in Turkey between 2012 and 2013 and characterized. MV RNA sequences (n = 60) were analysed for 456 nucleotides representing hypervariable domain of the nucleoprotein (N) gene. Of the 60 strains analysed 53 were the D8 genotype, 6 were B3, 1 was D4, and 1 was A. This report describes MV genotype D8 that was involved in a measles outbreak in Turkey. Sequences of most genotype D8 strains (n = 51) were identical to the sequence of variant D8-Frankfurt-Main, which has been associated with outbreaks throughout Europe. Despite the lack of epidemiologic information, a phylogenetic analysis suggested that the genotype D8 MV may have been brought to Turkey from elsewhere. Phylogenetic and epidemiological findings suggested that strains identified in tourists and associated with importation included one strain of genotype D8, one strain of genotype B3, and one strain of genotype D4. These findings from the 2012 to 2013 outbreak in Turkey confirm that pockets of unimmunised individuals are making the country susceptible to measles outbreaks. To prevent further outbreaks, deliberate and sustained effort must be made to reach, and immunise susceptible age groups. Towards measles elimination process, continued molecular surveillance of measles strains in Turkey will help identify transmission patterns of virus and evaluate vaccination efforts. J. Med. Virol. 88:1867-1873, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Atila T Kalaycioglu
- Molecular Microbiology Research and Application Laboratory, Public Health Agency, Ankara, Turkey
- Faculty of Pharmacy, Department of Basic Pharmaceutical, Karadeniz Technical University, Trabzon, Turkey
| | - Sultan Yolbakan
- Virology Reference Laboratory, Public Health Agency, Ankara, Turkey
| | - Dilek Guldemir
- Molecular Microbiology Research and Application Laboratory, Public Health Agency, Ankara, Turkey
| | | | - Aslihan Coskun
- Virology Reference Laboratory, Public Health Agency, Ankara, Turkey
| | - Yasemin Cosgun
- Virology Reference Laboratory, Public Health Agency, Ankara, Turkey
| | - Riza Durmaz
- Molecular Microbiology Research and Application Laboratory, Public Health Agency, Ankara, Turkey
- Faculty of Medicine, Department of Medical Microbiology, Yildirim Beyazıt University, Ankara, Turkey
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17
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Hukic M, Ravlija J, Karakas S, Mulaomerovic M, Dedeic Ljubovic A, Salimović-Besic I, Seremet M, Ahmetagic S, Comor A, Feric E. An ongoing measles outbreak in the Federation of Bosnia and Herzegovina, 2014 to 2015. ACTA ACUST UNITED AC 2015; 20. [PMID: 25764186 DOI: 10.2807/1560-7917.es2015.20.9.21047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Between January 2014 and the beginning of February 2015, the Federal Institute of Public Health in the Federation of Bosnia and Herzegovina has reported 3,804 measles cases. Notable transmission has been observed in three Central Bosnia Canton municipalities: Bugojno, Fojnica and Travnik. Most cases were unvaccinated 2,680 (70%) or of unknown vaccination status 755 (20%). Health authorities have been checking vaccination records and performing necessary prevention measures. The epidemic is still ongoing.
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Affiliation(s)
- M Hukic
- Department of Medical Science, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
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