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Kuba Y, Nidaira M, Maeshiro N, Komase K, Kamiya H, Kyan H. Analysis of Suspected Measles Cases with Discrepant Measles-Specific IgM and rRT-PCR Test Results, Japan. Emerg Infect Dis 2024; 30:926-933. [PMID: 38579738 PMCID: PMC11060445 DOI: 10.3201/eid3005.231757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
We investigated clinically suspected measles cases that had discrepant real-time reverse transcription PCR (rRT-PCR) and measles-specific IgM test results to determine diagnoses. We performed rRT-PCR and measles-specific IgM testing on samples from 541 suspected measles cases. Of the 24 IgM-positive and rRT-PCR--negative cases, 20 were among children who received a measles-containing vaccine within the previous 6 months; most had low IgG relative avidity indexes (RAIs). The other 4 cases were among adults who had an unknown previous measles history, unknown vaccination status, and high RAIs. We detected viral nucleic acid for viruses other than measles in 15 (62.5%) of the 24 cases with discrepant rRT-PCR and IgM test results. Measles vaccination, measles history, and contact history should be considered in suspected measles cases with discrepant rRT-PCR and IgM test results. If in doubt, measles IgG avidity and PCR testing for other febrile exanthematous viruses can help confirm or refute the diagnosis.
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Affiliation(s)
| | - Minoru Nidaira
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Noriyuki Maeshiro
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Katsuhiro Komase
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Hajime Kamiya
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Hisako Kyan
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
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Namuwulya P, Ashraf S, Niebel M, Ssekagiri A, Tushabe P, Kakooza P, Tong L, Bukenya H, Jerome H, Davis C, Birungi M, Turyahabwe I, Mugaga A, Eliku JP, Francis A, Nakabazzi L, Nsubuga F, Katushabe E, Kisakye A, Ampeire I, Nanteza A, Kaleebu P, Bakamutumaho B, Nsamba P, Kazibwe A, da Silva Filipe A, Tweyongyere R, Bwogi J, Thomson EC. Viruses associated with measles-like illnesses in Uganda. J Infect 2024; 88:106148. [PMID: 38588959 PMCID: PMC11060986 DOI: 10.1016/j.jinf.2024.106148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/13/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES In this study, we investigated the causes of measles-like illnesses (MLI) in the Uganda national surveillance program in order to inform diagnostic assay selection and vaccination strategies. METHODS We used metagenomic next-generation sequencing (M-NGS) on the Illumina platform to identify viruses associated with MLI (defined as fever and rash in the presence of either cough, coryza or conjunctivitis) in patient samples that had tested IgM negative for measles between 2010 and 2019. RESULTS Viral genomes were identified in 87/271 (32%) of samples, of which 44/271 (16%) contained 12 known viral pathogens. Expected viruses included rubella, human parvovirus B19, Epstein Barr virus, human herpesvirus 6B, human cytomegalovirus, varicella zoster virus and measles virus (detected within the seronegative window-period of infection) and the blood-borne hepatitis B virus. We also detected Saffold virus, human parvovirus type 4, the human adenovirus C2 and vaccine-associated poliovirus type 1. CONCLUSIONS The study highlights the presence of undiagnosed viruses causing MLI in Uganda, including vaccine-preventable illnesses. NGS can be used to monitor common viral infections at a population level, especially in regions where such infections are prevalent, including low and middle income countries to guide vaccination policy and optimize diagnostic assays.
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Affiliation(s)
| | - Shirin Ashraf
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | - Marc Niebel
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | | | | | | | - Lily Tong
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | - Henry Bukenya
- Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | - Hanna Jerome
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | - Chris Davis
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK
| | - Molly Birungi
- Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | | | - Arnold Mugaga
- Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | | | - Aine Francis
- Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | | | | | | | | | | | - Ann Nanteza
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | | | - Peninah Nsamba
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Anne Kazibwe
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Robert Tweyongyere
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | | | - Emma C Thomson
- MRC - University of Glasgow Centre for Virus Research (CVR), Glasgow, UK; London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
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Stein-Zamir C, Abramson N, Sokolov I, Mor-Shimshi L, Shoob H. Case Ascertainment of Measles during a Large Outbreak-Laboratory Compared to Epidemiological Confirmation. Diagnostics (Basel) 2024; 14:943. [PMID: 38732357 PMCID: PMC11082954 DOI: 10.3390/diagnostics14090943] [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: 02/01/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Measles is a highly contagious viral disease, and hence, sufficient herd immunity is obligatory to prevent infection transmission. Measles is still a cause of considerable disease burden globally, mainly in children. During a national measles outbreak in Israel in 2018-2019, the peak incidence rates occurred in the Jerusalem district. Most measles cases in the Jerusalem district (75.5%, 1702) were observed in children younger than 15 years of age, 49.2% (1109) were in children under 5 years of age, and 18.9% (425) were in infants under 1 year of age. The routine measles vaccination schedule includes two doses at 1 and 6 years of age. Most cases (1828, 81.1%) were unvaccinated (zero measles vaccine doses). These cases comprised the 425 affected infants under 1 year of age, who were ineligible for vaccination, along with the 1403 children over 1 year of age, who were otherwise unvaccinated. This study aimed to describe the epidemiologic and laboratory features of this measles outbreak, and to investigate case ascertainment (laboratory confirmed compared to epidemiologically confirmed cases). The study population included 2254 measles cases notified during the period spanning June 2018 to May 2019 in the Jerusalem district (incidence rate 176 per 10,000 population). Of the 2254 cases, 716 (31.8%) were laboratory confirmed, and 1538 (68.2%) were confirmed as epidemiologically linked. Most laboratory confirmed cases (420, 58.7%) underwent real-time PCR tests. Serological tests (measles IgM and IgG) were used in 189 (26.4%) cases, and a combination of RT-PCR and serology was used in 107 (14.9%) cases. In a multivariate model analysis, the variables significantly associated (after adjustment) with higher odds for laboratory confirmation included month of disease onset (late), additional measles cases in the household (single case), place of medical treatment (hospital; either emergency department, or hospitalization) and vaccination status (at least one prior vaccine dose). The measles outbreak described demonstrates the urgency of addressing vaccination gaps with appropriate outbreak prevention programs. The road to measles elimination needs to be paved with robust public health infrastructure, excellent field epidemiology for outbreak surveillance, investigation, and control, and laboratory proficiency.
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Affiliation(s)
- Chen Stein-Zamir
- Jerusalem District Health Office, Ministry of Health, Jerusalem 9134302, Israel; (N.A.); (I.S.); (L.M.-S.); (H.S.)
- Faculty of Medicine, Hadassah Braun School of Public Health and Community Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Nitza Abramson
- Jerusalem District Health Office, Ministry of Health, Jerusalem 9134302, Israel; (N.A.); (I.S.); (L.M.-S.); (H.S.)
| | - Irina Sokolov
- Jerusalem District Health Office, Ministry of Health, Jerusalem 9134302, Israel; (N.A.); (I.S.); (L.M.-S.); (H.S.)
| | - Lia Mor-Shimshi
- Jerusalem District Health Office, Ministry of Health, Jerusalem 9134302, Israel; (N.A.); (I.S.); (L.M.-S.); (H.S.)
| | - Hanna Shoob
- Jerusalem District Health Office, Ministry of Health, Jerusalem 9134302, Israel; (N.A.); (I.S.); (L.M.-S.); (H.S.)
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Coan EW, Tuon FF. Laboratory diagnosis of measles infection using molecular and serology during 2019-2020 outbreak in Brazil. J Clin Virol 2024; 170:105623. [PMID: 38065047 DOI: 10.1016/j.jcv.2023.105623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
INTRODUCTION Laboratory diagnosis of measles can be challenging, and the reintroduction of the measles virus in Brazil has brought about new issues. The aim of this study was to analyze the qPCR results of swab and urine samples and compare them with those of immunological methods for the diagnosis of measles. METHODS This was a cross-sectional study based on a retrospective analysis of 3,451 suspected cases using laboratory test surveillance databases for qPCR (respiratory swabs and urine) and serologic tests for IgM and paired IgG. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and agreement through kappa and adjusted kappa coefficients (PABAK) were calculated using different diagnostic strategies. RESULTS The swab and urine samples obtained using real-time qPCR were equivalent. Samples collected simultaneously and the combined samples showed moderate agreement between IgM ELISA and real-time qPCR; however, 48.9 % of the IgM ELISA analyses did not demonstrate detectable qPCR concentrations during simultaneous collections and 43.9 % of combined collections. The paired analysis of IgG showed an accuracy of 67.5 % for IgM and 90.7 % for real-time qPCR. CONCLUSIONS Diagnosis based on IgM presents detection delimitation in samples collected early (1-5 days), suggesting that these individuals satisfy at least two criteria. In addition to qPCR, paired analysis of IgG using ELISA can be used to increase the sensitivity and specificity of laboratory diagnoses.
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Affiliation(s)
- Etienne Wessler Coan
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, Pontifícia Universidade Católica do Paraná, Curitiba PR, Brazil.
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Walter J, Eludin Z, Drabovich AP. Redefining serological diagnostics with immunoaffinity proteomics. Clin Proteomics 2023; 20:42. [PMID: 37821808 PMCID: PMC10568870 DOI: 10.1186/s12014-023-09431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
Serological diagnostics is generally defined as the detection of specific human immunoglobulins developed against viral, bacterial, or parasitic diseases. Serological tests facilitate the detection of past infections, evaluate immune status, and provide prognostic information. Serological assays were traditionally implemented as indirect immunoassays, and their design has not changed for decades. The advantages of straightforward setup and manufacturing, analytical sensitivity and specificity, affordability, and high-throughput measurements were accompanied by limitations such as semi-quantitative measurements, lack of universal reference standards, potential cross-reactivity, and challenges with multiplexing the complete panel of human immunoglobulin isotypes and subclasses. Redesign of conventional serological tests to include multiplex quantification of immunoglobulin isotypes and subclasses, utilize universal reference standards, and minimize cross-reactivity and non-specific binding will facilitate the development of assays with higher diagnostic specificity. Improved serological assays with higher diagnostic specificity will enable screenings of asymptomatic populations and may provide earlier detection of infectious diseases, autoimmune disorders, and cancer. In this review, we present the major clinical needs for serological diagnostics, overview conventional immunoassay detection techniques, present the emerging immunoassay detection technologies, and discuss in detail the advantages and limitations of mass spectrometry and immunoaffinity proteomics for serological diagnostics. Finally, we explore the design of novel immunoaffinity-proteomic assays to evaluate cell-mediated immunity and advance the sequencing of clinically relevant immunoglobulins.
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Affiliation(s)
- Jonathan Walter
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, 10-102 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Zicki Eludin
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, 10-102 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Andrei P Drabovich
- Division of Analytical and Environmental Toxicology, Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, 10-102 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada.
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Fappani C, Gori M, Bianchi S, Terraneo M, Bilardi E, Colzani D, Tanzi E, Canuti M, Amendola A. Differential diagnosis of fever and rash cases negative for measles and rubella to complement surveillance activities. J Med Virol 2023; 95:e29141. [PMID: 37796084 DOI: 10.1002/jmv.29141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/09/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
In the quest to eliminate measles virus (MV) and rubella virus (Ruv), every suspected case must be properly identified and diagnosed. Since 2017, in Milan (Italy), a total of 978 measles and rubella suspected cases (fever and rash) were investigated and 310 were not laboratory confirmed (discarded cases). To improve surveillance activities, we investigated the presence in discarded cases of 8 other viral pathogens commonly associated with rash: human herpesvirus 6 (HHV-6) and 7 (HHV-7), parvovirus B19 (B19V), enterovirus (EV), Epstein-Barr virus (EBV), human adenovirus (HAdV), cytomegalovirus (HCMV), and SARS-CoV-2. Differential diagnosis was carried out on 289 discarded cases by multiplex real-time PCR assays. At least one pathogen was detected in 188 cases (65.1%) with HHV-7 being the most frequently detected virus. No difference in the number of detected infections overtime was observed and infections were identified in all age groups. As expected, most HHV-6, EV, HAdV, and HCMV-positive cases were found in children aged 0-4 years and HHV-7 was most frequent in the 15-39 age group. In light of the World Health Organization measles elimination goal, the introduction of laboratory methods for differential diagnosis is required for the final classification of clinically compatible cases. The used screening panel allowed us to increase the percentage of virus-positive cases to 87.5%, allowing us to clarify viral involvement and epidemiology, improve diagnosis, and strengthen surveillance activities. As all investigated pathogens were detected, this diagnostic panel was a suitable tool to complement MV and RuV surveillance activities.
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Affiliation(s)
- Clara Fappani
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Coordinate Research Centre EpiSoMI (Epidemiology and Molecular Surveillance of Infections), Università degli Studi di Milano, Milan, Italy
| | - Maria Gori
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Coordinate Research Centre EpiSoMI (Epidemiology and Molecular Surveillance of Infections), Università degli Studi di Milano, Milan, Italy
| | - Silvia Bianchi
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Coordinate Research Centre EpiSoMI (Epidemiology and Molecular Surveillance of Infections), Università degli Studi di Milano, Milan, Italy
| | - Mara Terraneo
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Erica Bilardi
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Daniela Colzani
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elisabetta Tanzi
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Coordinate Research Centre EpiSoMI (Epidemiology and Molecular Surveillance of Infections), Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
| | - Marta Canuti
- Coordinate Research Centre EpiSoMI (Epidemiology and Molecular Surveillance of Infections), Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Antonella Amendola
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Coordinate Research Centre EpiSoMI (Epidemiology and Molecular Surveillance of Infections), Università degli Studi di Milano, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, Milan, Italy
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Kanbayashi D, Kurata T, Kaida A, Kubo H, Yamamoto SP, Egawa K, Hirai Y, Okada K, Kaida Y, Ikemori R, Yumisashi T, Ito A, Saito T, Yamaji Y, Nishino Y, Omori R, Mori H, Motomura K, Ikuta K. Shedding of rubella virus in postsymptomatic individuals; viral RNA load is a potential indicator to estimate candidate patients excreting infectious rubella virus. J Clin Virol 2023; 160:105377. [PMID: 36682339 DOI: 10.1016/j.jcv.2022.105377] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/25/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Since the first isolation of rubella virus (RuV) in 1962, comprehensive data regarding the quantitative evaluation of RuV shedding remain unavailable. In this study, we evaluated the shedding of viral RNA and infectious virus in patients with acute RuV infection. STUDY DESIGN We analyzed 767 specimens, including serum/plasma, peripheral blood mononuclear cells (PBMCs), throat swabs, and urine, obtained from 251 patients with rubella. The viral RNA load and the presence of infectious RuV were determined using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and virus isolation. RESULTS Virus excretion peaked 0-2 days after rash onset and decreased over time. The median viral RNA load dropped to an undetectable level on day 3 after rash onset in serum/plasma, day 2 in PBMCs, days 10-13 in throat swabs, and days 6-7 in urine. Infectious virus could be isolated for up to day 2 after rash onset in serum/plasma, day 1 in PBMCs, days 8-9 in throat swabs, and days 4-5 in urine. The minimum viral RNA load that allowed virus isolation was 961 copies/mL in serum/plasma, 784 copies/mL in PBMCs, 650 copies/mL in throat swabs, and 304 copies/mL in urine. A higher viral RNA load indicated a higher likelihood of the presence of infectious virus. CONCLUSION These findings would contribute to improve algorithms for rubella surveillance and diagnosis. In addition, this study indicates that the results of RT-qPCR enable efficient rubella control by estimating candidate patients excreting infectious virus, which could help prevent viral transmission at an early stage and eliminate rubella ultimately.
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Affiliation(s)
- Daiki Kanbayashi
- Division of Virology, Osaka Institute of Public Health, Osaka, 537-0025, Japan.
| | - Takako Kurata
- Division of Virology, Osaka Institute of Public Health, Osaka, 537-0025, Japan
| | - Atsushi Kaida
- Division of Microbiology, Osaka Institute of Public Health, Osaka, 543-0026, Japan
| | - Hideyuki Kubo
- Division of Microbiology, Osaka Institute of Public Health, Osaka, 543-0026, Japan
| | - Seiji P Yamamoto
- Division of Microbiology, Osaka Institute of Public Health, Osaka, 543-0026, Japan
| | - Kazutaka Egawa
- Division of Microbiology, Osaka Institute of Public Health, Osaka, 543-0026, Japan
| | - Yuki Hirai
- Division of Microbiology, Osaka Institute of Public Health, Osaka, 543-0026, Japan
| | - Kazuma Okada
- Division of Microbiology, Osaka Institute of Public Health, Osaka, 543-0026, Japan
| | - Yuko Kaida
- Division of Virology, Osaka Institute of Public Health, Osaka, 537-0025, Japan
| | - Ryo Ikemori
- Division of Virology, Osaka Institute of Public Health, Osaka, 537-0025, Japan
| | - Takahiro Yumisashi
- Division of Virology, Osaka Institute of Public Health, Osaka, 537-0025, Japan
| | - Ayami Ito
- Osaka City Public Health Bureau, Osaka City Health Center, Osaka, 545-0051, Japan
| | - Takeshi Saito
- Osaka City Public Health Bureau, Osaka City Health Center, Osaka, 545-0051, Japan
| | - Yoshihiko Yamaji
- Department of Public Health and Medical Affairs, Osaka Prefectural Government, Osaka, 540-8570, Japan
| | - Yuka Nishino
- Department of Public Health and Medical Affairs, Osaka Prefectural Government, Osaka, 540-8570, Japan
| | - Ryosuke Omori
- International Institute for Zoonosis Control, Hokkaido University, Hokkaido, 001-0020, Japan
| | - Haruyo Mori
- Division of Virology, Osaka Institute of Public Health, Osaka, 537-0025, Japan
| | - Kazushi Motomura
- Division of Virology, Osaka Institute of Public Health, Osaka, 537-0025, Japan
| | - Kazuyoshi Ikuta
- Division of Virology, Osaka Institute of Public Health, Osaka, 537-0025, Japan; Research Institute for Microbial Diseases, Osaka University, Osaka, 565-0871, Japan; BioAcademia Inc., Osaka, 565-0871, Japan
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Seto J, Aoki Y, Komabayashi K, Yamada K, Ishikawa H, Ichikawa T, Ahiko T, Mizuta K. Measles Outbreak Response Activity in Japan, and a Discussion for a Possible Strategy of Outbreak Response Using Cycle Threshold Values of Real-Time Reverse Transcription PCR for Measles Virus in Measles Elimination Settings. Viruses 2023; 15:171. [PMID: 36680212 PMCID: PMC9863267 DOI: 10.3390/v15010171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Measles is a highly contagious, but vaccine-preventable disease caused by the measles virus (MeV). Although the administration of two doses of measles vaccines is the most effective strategy to prevent and eliminate measles, MeV continues to spread worldwide, even in 2022. In measles-eliminated countries, preparedness and response to measles outbreaks originating from imported cases are required to maintain elimination status. Under these circumstances, real-time reverse transcription (RT) PCR for MeV could provide a diagnostic method capable of strengthening the subnational capacity for outbreak responses. Real-time RT-PCR can detect MeV RNA from patients with measles at the initial symptomatic stage, which can enable rapid public health responses aimed at detecting their contacts and common sources of infection. Furthermore, low cycle threshold (Ct) values (i.e., high viral load) of throat swabs indicate high infectiousness in patients with measles. The high basic reproduction number of measles suggests that patients with high infectiousness can easily become super-spreaders. This opinion proposes a possible strategy of rapid and intensive responses to counter measles outbreaks caused by super-spreader candidates showing low Ct values in throat swabs. Our strategy would make it possible to effectively prevent further measles transmission, thereby leading to the early termination of measles outbreaks.
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Affiliation(s)
- Junji Seto
- Yamagata Prefectural Institute of Public Health, Yamagata 990-0031, Japan
| | - Yoko Aoki
- Yamagata Prefectural Institute of Public Health, Yamagata 990-0031, Japan
| | | | - Keiko Yamada
- Okitama Public Health Center, Yamagata 992-0012, Japan
| | - Hitoshi Ishikawa
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata 990-2212, Japan
| | - Tomoo Ichikawa
- Department of Society and Regional Culture, Okinawa International University, Ginowan 901-2701, Japan
| | - Tadayuki Ahiko
- Yamagata Prefectural Institute of Public Health, Yamagata 990-0031, Japan
- Department of Health and Welfare, Yamagata Prefectural Government, Yamagata 990-8570, Japan
| | - Katsumi Mizuta
- Yamagata Prefectural Institute of Public Health, Yamagata 990-0031, Japan
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Torner N, Mercader S, Dominguez A, Martinez A, Costa J, Sowers SB, Abernathy ES, Bellini WJ, Hickman CJ. Etiological analysis of discarded measles in the context of a measles outbreak among a highly immunized population. Pediatr Int 2023; 65:e15430. [PMID: 36461709 PMCID: PMC10107150 DOI: 10.1111/ped.15430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Measles can lead to serious complications and remains an important cause of morbidity and mortality worldwide. In this study we aimed to assess the etiological diagnosis of discarded measles cases in the context of an outbreak among a highly immunized population. METHODS We conducted a retrospective observational study of discarded measles cases from an outbreak that occurred from October 2006 to July 2007 in Catalonia. A confirmed case was defined as having a positive measles serum IgM result and/or a positive result by RT-PCR in urine and/or nasopharyngeal swab; or an epidemiological link to a confirmed case. Serum specimens were tested by a commercially available indirect-format and by an in-house capture-format measles IgM enzyme immunoassays. RESULTS Testing of 89 samples discarded for measles determined the etiologies for 10 (11.2%), including one rubella, three human herpes virus 6, and six measles infections. Of 381 confirmed cases in the outbreak, 10% had received at least one dose of the measles-mumps-rubella vaccine versus 54% of the discarded for measles (OR: 0.09; 95% CI: 0.06, 0.14; p < 0.001). CONCLUSIONS Highly sensitive surveillance systems are critical to identifying cases, responding to outbreaks and verifying progress towards measles elimination. Molecular tools for measles detection and differential diagnosis, and collection of appropriate specimens for molecular and serological testing are essential to correctly diagnose suspected measles infection.
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Affiliation(s)
- Nuria Torner
- CIBER Epidemiology and Public Health CIBERESPInstitute Carlos IIIMadridSpain
- Department of MedicineUniversity of BarcelonaBarcelonaSpain
| | - Sara Mercader
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
| | - Angela Dominguez
- CIBER Epidemiology and Public Health CIBERESPInstitute Carlos IIIMadridSpain
- Department of MedicineUniversity of BarcelonaBarcelonaSpain
| | - Ana Martinez
- CIBER Epidemiology and Public Health CIBERESPInstitute Carlos IIIMadridSpain
- Public Health Agency of CataloniaBarcelonaSpain
| | - Josep Costa
- Virology Unit, Centre de Diagnòstic BiomèdicHospital ClínicBarcelonaSpain
| | - Sun B. Sowers
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
| | - Emily S. Abernathy
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
| | - William J. Bellini
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
| | - Carol J. Hickman
- Division of Viral Diseases, Centers for Disease Control and PreventionNational Center for Immunization and Respiratory DiseasesAtlantaGeorgiaUSA
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10
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Yılmaz TD, Üçeş Harmanoğulları L. Infectious Diseases and Migration: Measles Cases in a Province, Turkey Before and After the Pandemic. GÜNCEL PEDIATRI 2022. [DOI: 10.4274/jcp.2022.82246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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11
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Herini ES, Triono A, Iskandar K, Nuady A, Pujiastuti LH, Marcellus, Nugrahanto AP, Kamal M, Gunadi. Phylogenetic analysis of congenital rubella virus from Indonesia: a case report. BMC Pediatr 2022; 22:713. [PMID: 36513987 PMCID: PMC9745697 DOI: 10.1186/s12887-022-03775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rubella is a common inherited infection resulting in congenital cataracts and a significant cause of permanent vision loss in developing countries. In 2016, Indonesia had the highest number of congenital rubella syndrome (CRS) cases globally. Here, we report the first genotype of the rubella virus extracted from the eye lens from a child with congenital cataracts due to CRS. CASE PRESENTATION A female neonate was delivered by an elective caesarean delivery with normal birth weight at term from a 24-year-old mother in the rural setting. The baby presented with bilateral congenital cataracts, small-moderate secundum atrial septal defect, severe supravalvular pulmonary stenosis, and profound bilateral hearing loss. She also had microcephaly and splenomegaly. The patient's serology showed persistent positive IgG for rubella virus at the age of four years and four months. Following extraction during cataract surgery, viral detection of the lenses identified the presence of rubella. Phylogenetic analysis confirmed that the virus was grouped into genotype 1E. CONCLUSIONS Our study reports the first phylogenetic analysis of the rubella virus extracted from the eye lens of a child with CRS in Indonesia. The detection of the rubella virus from eye lenses is remarkably promising. Our findings also emphasize the importance of molecular epidemiology in tracking the origin of rubella infection toward achieving virus eradication.
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Affiliation(s)
- Elisabeth Siti Herini
- grid.8570.a0000 0001 2152 4506Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281 Indonesia
| | - Agung Triono
- grid.8570.a0000 0001 2152 4506Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281 Indonesia
| | - Kristy Iskandar
- grid.8570.a0000 0001 2152 4506Department of Child Health/Genetics Working Group, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/UGM Academic Hospital, Yogyakarta, 55281 Indonesia
| | - Albaaza Nuady
- grid.8570.a0000 0001 2152 4506Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281 Indonesia
| | | | - Marcellus
- grid.8570.a0000 0001 2152 4506Pediatric Surgery Division, Department of Surgery/Genetics Working Group, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281 Indonesia
| | - Andika Priamas Nugrahanto
- grid.8570.a0000 0001 2152 4506Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281 Indonesia
| | - Musthofa Kamal
- World Health Organization (WHO) Indonesia Representative, Jakarta, 12940 Indonesia
| | - Gunadi
- Pediatric Surgery Division, Department of Surgery/Genetics Working Group, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia.
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12
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González-Praetorius A, Fernández-García A, Pérez-Olmeda M, García-Rivera MV, Caballero-López B, Gilaberte-Reyzabal S, Román-Marcos E, Ory-Machón FD, Echevarría-Mayo JE. Measles outbreak in the sanitary area of Guadalajara (Spain): difficulty in microbiological diagnosis in the era of its elimination. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:532-538. [PMID: 35811250 DOI: 10.1016/j.eimce.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tolos for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). METHODS Serological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. RESULTS A total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in two that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or two vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. CONCLUSIONS The combination of molecular tests and the presence of specific IgM is necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.
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Affiliation(s)
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Centro de Investigación, Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M Victoria García-Rivera
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, Spain
| | | | | | - Elena Román-Marcos
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, Spain
| | - Fernando de Ory-Machón
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Centro de Investigación, Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Emilio Echevarría-Mayo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Centro de Investigación, Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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13
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Turaiche M, Feciche B, Gluhovschi A, Bratosin F, Bogdan I, Bota AV, Grigoras ML, Gurban CV, Cerbu B, Toma AO, Gurumurthy S, Wulandari PH, Marincu I. Biological Profile and Clinical Features as Determinants for Prolonged Hospitalization in Adult Patients with Measles: A Monocentric Study in Western Romania. Pathogens 2022; 11:pathogens11091018. [PMID: 36145449 PMCID: PMC9505879 DOI: 10.3390/pathogens11091018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Measles is a highly infectious and sometimes deadly illness that is preventable with vaccination. The present research aims to analyze the most recent measles epidemic from Romania that occurred in a population with a falling desire to receive immunizations, by detailing the clinical picture and biological profile of hospitalized patients. A secondary goal of the present research is to identify characteristics that increase the likelihood of a longer hospitalization and the development of measles-related pneumonia. A retrospective cohort study was conducted to follow the course and effects of measles virus infection in adult hospitalized patients who were divided into two groups based on whether they had been in the hospital for more than 6 days or fewer than 6 days. A total of 114 adult patients with measles were eligible to participate in the trial if they had a positive measles-specific IgM antibody test resulting from the study. The average age in the short hospital stay group was 28.1 years, while the average age in the long hospital stay group was 31.9 years. There was a statistically significant difference in the number of Roma persons in the research groups, with 17.4 percent of them having a lengthy hospital stay compared to 5.9 percent in the group with a short hospital stay, according to the findings. It was observed that many patients had a long hospitalization associated with chronic lung disease (OR = 1.07), liver damage (OR = 1.66), Roma ethnicity (OR = 1.79), a long duration elapsed from the last MMR dose (OR = 2.02), elevated c-reactive protein (OR = 2.17), the presence of bilateral pulmonary condensations on X-ray (OR = 3.13), and elevated procalcitonin (OR = 3.49). The same significant independent risk factors were also associated with the development of pneumonia. It is of imperative need to address these risk factors in a patient with measles, moreover in association with an unknown status of vaccination. Vaccination awareness against measles must be pushed in Romania to determine a higher than 95% coverage. Significant efforts are still needed to ensure improved protection against measles epidemics within a specific region or population and, more importantly, in patients with significant risk factors for complications, as described in this study.
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Affiliation(s)
- Mirela Turaiche
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Feciche
- Department of Urology, Satu-Mare County Emergency Hospital, Strada Ravensburg 2, 440192 Satu-Mare, Romania
| | - Adrian Gluhovschi
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Correspondence:
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Iulia Bogdan
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Adrian Vasile Bota
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mirela Loredana Grigoras
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Camelia Vidita Gurban
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Department of Biochemistry, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Bianca Cerbu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ana-Olivia Toma
- Department of Microbiology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Srivathsava Gurumurthy
- Mysore Medical College and Research Institute, Rajiv Gandhi University of Health Sciences, Irwin Road, Mysuru 570001, India
| | | | - Iosif Marincu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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14
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Yousif M, Hong H, Malfeld S, Smit S, Makhathini L, Motsamai T, Tselana D, Manamela M, Kamupira M, Maseti E, Ranchod H, Otwombe K, McCarthy K, Suchard M. Measles incidence in South Africa: a six-year review, 2015-2020. BMC Public Health 2022; 22:1647. [PMID: 36042453 PMCID: PMC9427172 DOI: 10.1186/s12889-022-14069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022] Open
Abstract
In 2012 the World Health Organization (WHO) aimed to eliminate measles in five regions by 2020. This retrospective descriptive study reviewed measles surveillance data in South Africa for the period 2015—2020 to document the epidemiology of measles and the progress made towards meeting the 2020 measles elimination goal. A total of 22,578 specimens were tested over the period 2015—2020 yielding 401 (1.8%) confirmed measles cases, 321 (1.4%) compatible and 21,856 (96.8%) discarded cases. The most affected age group was 0–4 year olds. At the provincial level, South Africa achieved adequate surveillance, defined as more than two cases of febrile rash notified annually per 100 000 popoulation, except for KwaZulu-Natal and Limpopo in 2020, probably due to COVID-19 lockdown restrictions. Of confirmed cases, only 26% were vaccinated, 3% were too young to receive vaccines, 5% were not vaccinated, and 65% had unknown vaccination status. Measles vaccine effectiveness amongst 1–4 year olds was 80%. Using the standard case definition, South Africa achieved the measles elimination target of less than one case per one million nationally in years 2015, 2016 and 2020. The years 2017 to 2019 had incidence rates exceeding one per million nationally. Using a narrow case definition, that excluded positive rubella cases, improved the indicators with only the year 2017 having an incidence rate of more than one per million. South Africa displays intermittent measles outbreaks approximately six-yearly interspersed by inter-epidemic periods in which the country meets measles elimination targets. Intense effort is needed to increase the vaccine coverage to avoid periodic outbreaks. Enhanced molecular testing of each case will be required as measles incidence declines regionally.
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Affiliation(s)
- Mukhlid Yousif
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa. .,Department of Virology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Heather Hong
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Susan Malfeld
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Sheilagh Smit
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Lillian Makhathini
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Tshepo Motsamai
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Dipolelo Tselana
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Morubula Manamela
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Mercy Kamupira
- World Health Organization, Pretoria, South Africa.,UNICEF, Pretoria, South Africa
| | - Elizabeth Maseti
- Child, Youth and School Health, National Department of Health, Pretoria, South Africa
| | - Heena Ranchod
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Department of Chemical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerrigan McCarthy
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Melinda Suchard
- Centre for Vaccines and Immunology, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.,Department of Chemical Pathology, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa
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15
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Namuwulya P, Bukenya H, Tushabe P, Tweyongyere R, Bwogi J, Cotten M, Phan MVT. Near-Complete Genome Sequences of Measles Virus Strains from 10 Years of Uganda Country-wide Surveillance. Microbiol Resour Announc 2022; 11:e0060622. [PMID: 35876572 PMCID: PMC9387275 DOI: 10.1128/mra.00606-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/08/2022] [Indexed: 11/20/2022] Open
Abstract
Measles remains a global health challenge despite the availability of a safe and effective vaccine. Sporadic outbreaks of measles virus infections continue in Uganda. We report eight near-complete genome sequences of measles virus strains from Uganda cases from 2011 to 2020, providing useful data for assessing vaccine escape and local/regional transmission.
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Affiliation(s)
| | | | | | - Robert Tweyongyere
- Department of Veterinary Pharmacy Clinical and Comparative Medicine, Makerere University, Kampala, Uganda
| | | | - Matthew Cotten
- U.K. Medical Research Council-Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- U.K. Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, Scotland, United Kingdom
| | - My V. T. Phan
- U.K. Medical Research Council-Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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16
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Feutz K, Shirey D. Measles: Moving toward eradication. Nurse Pract 2022; 47:14-20. [PMID: 35470329 DOI: 10.1097/01.npr.0000827116.22104.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABSTRACT Measles is a vaccine-preventable, highly contagious virus once considered eradicated in the US. It is still a significant source of morbidity and mortality for children under 5 years of age worldwide. Advanced practice registered nurses are on the frontlines of reducing the spread of disease and educating the community on measles prevention.
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17
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Measles-Rubella Positivity Rate and Associated Factors in Pre-Mass and Post-Mass Vaccination Periods: Analysis of Uganda Routine Surveillance Laboratory Data. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/5080631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Toward 2019, Uganda experienced an extensive outbreak of measles and rubella. The Uganda National Expanded Programme on Immunization implemented a mass measles-rubella vaccination campaign aimed at halting the ongoing transmission. This study determined the changes in the disease burden thereafter. We conducted a retrospective cross-sectional study on measles-rubella positivity and its associated factors in Uganda using 1697 case-based surveillance data for 2019 and 2020 stratified into two dispensations: prevaccination and postvaccination campaigns. Statistical tests employed in STATA 15 included chi-square, Fisher’s exact, and binomial tests. Measles positivity rates in the period before and after the mass immunization campaign were 41.88% (95% CI: 39.30–44.51) and 37.96% (95% CI: 32.81–43.40), respectively. For rubella, the positivity rate in the precampaign season was 21.73% (95% CI: 19.61–23.99) and in the postvaccination season was 6.65% (95% CI: 4.36–10.00). Binomial tests indicated that postcampaign positivity rates were significantly lower than the precampaign rate for measles (
) and rubella (
). Generally, age (χ2 = 58.94,
/χ2 = 51.91,
) and vaccination status (χ2 = 60.48,
/χ2 = 16.90,
) were associated with the measles positivity rate in both pre/postcampaign periods. Rubella positivity rate was associated with vaccination status (χ2 = 32.97,
/
) in both periods and age in the precampaign season (
). The measles-rubella mass campaign lessened rubella burden remarkably, but barely adequate change was observed in the extent of spread of measles. Children aged less than 9 months are at higher chances of testing positive amidst low vaccination levels among the eligible. The immunization programme must attain and maintain routine immunization coverage at 95% or more and roll out a second-dose measles-rubella vaccination to sustain the reduced disease burden.
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18
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Schulz H, Neale M, Zubach V, Severini A, Hiebert J. Development of a rapid, internally controlled, two target, real-time RT-PCR for detection of rubella virus. J Virol Methods 2022; 303:114500. [PMID: 35217102 DOI: 10.1016/j.jviromet.2022.114500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 11/19/2022]
Abstract
Rubella surveillance in elimination setting relies on rapid molecular detection of the virus. In this study a multiplex real-time RT-PCR assay for the detection of rubella virus was validated. The assay includes three independent probes with unique reporter dyes for the simultaneous detection of the rubella viral coding regions for envelope glycoprotein E1 and non-structural p150 protein, and an endogenous control (human RNaseP). Using dilution series of synthetic RNAs, the limits of detection were determined to be at least 50 copies of rubella RNA. The assay is reproducible with low intra-assay and inter-assay coefficients of variation for both the E1 and the p150 targets. After testing 62 confirmed rubella positive and 165 rubella negative archival clinical samples, the sensitivity and specificity of the multiplex assay were 98.4 and 100%, respectively. No cross reactivity was identified with clinical specimens positive for eleven other viruses. This multiplex assay successfully detected nine viral genotypes including the predominant genotypes 1E, 1 G, 1 J, and 2B as well as the 1a vaccine genotype.
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Affiliation(s)
- Helene Schulz
- Viral Exanthemata and STD Section, National Microbiology Laboratory, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, 745 Logan Avenue, Winnipeg, Manitoba, Postal Code R3E 3L5, Canada.
| | - Mackenzie Neale
- Viral Exanthemata and STD Section, National Microbiology Laboratory, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, 745 Logan Avenue, Winnipeg, Manitoba, Postal Code R3E 3L5, Canada.
| | - Vanessa Zubach
- Viral Exanthemata and STD Section, National Microbiology Laboratory, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, 745 Logan Avenue, Winnipeg, Manitoba, Postal Code R3E 3L5, Canada.
| | - Alberto Severini
- Viral Exanthemata and STD Section, National Microbiology Laboratory, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, 745 Logan Avenue, Winnipeg, Manitoba, Postal Code R3E 3L5, Canada; Department of Medical Microbiology and Infectious Diseases, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Joanne Hiebert
- Viral Exanthemata and STD Section, National Microbiology Laboratory, Public Health Agency of Canada, JC Wilt Infectious Diseases Research Centre, 745 Logan Avenue, Winnipeg, Manitoba, Postal Code R3E 3L5, Canada.
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19
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Abstract
Measles is a highly contagious, potentially fatal, but vaccine-preventable disease caused by measles virus. Symptoms include fever, maculopapular rash, and at least one of cough, coryza, or conjunctivitis, although vaccinated individuals can have milder or even no symptoms. Laboratory diagnosis relies largely on the detection of specific IgM antibodies in serum, dried blood spots, or oral fluid, or the detection of viral RNA in throat or nasopharyngeal swabs, urine, or oral fluid. Complications can affect many organs and often include otitis media, laryngotracheobronchitis, pneumonia, stomatitis, and diarrhoea. Neurological complications are uncommon but serious, and can occur during or soon after the acute disease (eg, acute disseminated encephalomyelitis) or months or even years later (eg, measles inclusion body encephalitis and subacute sclerosing panencephalitis). Patient management mainly involves supportive therapy, such as vitamin A supplementation, monitoring for and treatment of secondary bacterial infections with antibiotics, and rehydration in the case of severe diarrhoea. There is no specific antiviral therapy for the treatment of measles, and disease control largely depends on prevention. However, despite the availability of a safe and effective vaccine, measles is still endemic in many countries and causes considerable morbidity and mortality, especially among children in resource-poor settings. The low case numbers reported in 2020, after a worldwide resurgence of measles between 2017 and 2019, have to be interpreted cautiously, owing to the effect of the COVID-19 pandemic on disease surveillance. Disrupted vaccination activities during the pandemic increase the potential for another resurgence of measles in the near future, and effective, timely catch-up vaccination campaigns, strong commitment and leadership, and sufficient resources will be required to mitigate this threat.
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Affiliation(s)
- Judith M Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
| | - Ionela Gouandjika-Vasilache
- Laboratoire des Virus Entériques et de la Rougeole, Institut Pasteur de Bangui, Bangui, Central African Republic
| | - Julia Dina
- Virology Department, Normandie University, UNICAEN, INSERM U1311 DynaMicURe, Caen University Hospital, Caen, France
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20
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Pérez Olmeda M, Balfagón P, Camacho J, Dafouz D, de la Fuente J, Murillo MÁ, Muñoz JL, Fernández García A, Sanz JC, de Ory F. Comparative evaluation of assays for IgM detection of rubella and measles infections. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:22-27. [PMID: 34991849 DOI: 10.1016/j.eimce.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/23/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Serological diagnosis of infections due to measles and rubella viruses is done by IgM detection. The aim of this study was to comparatively evaluate commercial systems for detecting IgM against both viruses, including those of ELISA, in indirect and capture formats, chemiluminescence and electrochemiluminescence. METHODS Seven (for rubella) and six (for measles) assays were studied. One hundred and sixty two samples were included in the study (from 90 rubella and 72 measles cases), and all were analyzed in all the assays. RESULTS The ranges of sensitivity, specificity and agreement for rubella were 94.8-100%, 52.4-100% and 75.5-98.1%, respectively. The corresponding ranges for measles assays were 87.0-100%, 53.3-100%, and 73.0-99.4%. CONCLUSION The best-performing assays were chemiluminescence (for measles and rubella IgM), and electrochemiluminescence (for rubella IgM).
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Affiliation(s)
- Mayte Pérez Olmeda
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Pilar Balfagón
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Juan Camacho
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Desirée Dafouz
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Jesús de la Fuente
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - María Ángeles Murillo
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - José Luis Muñoz
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Aurora Fernández García
- Laboratorio de Aislamiento Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CiberESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos Sanz
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CiberESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando de Ory
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CiberESP), Instituto de Salud Carlos III, Madrid, Spain.
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21
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Evaluation of diagnostic accuracy of eight commercial assays for the detection of rubella virus specific IgM antibodies. J Clin Microbiol 2021; 60:e0159721. [PMID: 34705533 PMCID: PMC8769748 DOI: 10.1128/jcm.01597-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Rubella and congenital rubella syndrome are caused by the rubella virus and are preventable through vaccination, making disease eradication possible. Monitoring of progress toward global eradication and local elimination requires high-quality, sensitive disease surveillance that includes laboratory confirmation of cases. Previous evaluations of anti-rubella IgM detection methods resulted in the broad adoption of the Enzygnost (most recently manufactured by Siemens) enzyme-linked immunosorbent assay (ELISA) kits within WHO’s global measles and rubella laboratory network, but they have been discontinued. This study evaluated seven comparable ELISAs from six manufacturers (Trinity Biotech, Euroimmun, Clin-Tech, NovaTec and Virion\Serion) as well as one automated chemiluminescent assay (CLIA) from DiaSorin. These assays include three IgM capture assays and five indirect ELISAs. A panel of 238 sera was used for the evaluation that included 38 archival rubella IgM-positive sera and 200 sera collected from patients with symptomatically similar diseases, such as measles, dengue, parvovirus B19 infection, and roseola. With this panel of sera, the sensitivity of the methods ranged from 63.2% to 100% and the specificity from 80.0% to 99.5%. No single method had both sensitivity and specificity of >90%, unless sera with equivocal results were considered presumptively positive. Some assays, particularly the Serion ELISA, had a large number of false positives with parvovirus B19 IgM-positive sera as well as sera from confirmed measles cases. The performance characteristics identified in this evaluation serve as a reminder to not rely solely on rubella IgM results for case confirmation in elimination settings.
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22
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Abstract
Infants and young children are uniquely susceptible to primary viral and bacterial infections, predisposing them to responses of greater frequency and severity than in adults. Etiologies and manifestations of infections in pediatric patients are often different than those in adults. It can be challenging for clinical laboratories to implement appropriate microbiologic methods for rapid and accurate diagnoses in this population. Laboratorians should be cognizant of the distinctive features of children to provide comprehensive pediatric clinical microbiology services. This article discusses laboratory aspects of several clinically significant pediatric pathogens that cause severe harm to patients and impact public health responses.
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23
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González-Praetorius A, Fernández-García A, Pérez-Olmeda M, García-Rivera MV, Caballero-López B, Gilaberte-Reyzabal S, Román-Marcos E, de Ory-Machón F, Echevarría-Mayo JE. Measles outbreak in the sanitary area of Guadalajara (Spain): Difficulty in microbiological diagnosis in the era of its elimination. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00232-9. [PMID: 34429225 DOI: 10.1016/j.eimc.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION In Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tools for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). METHODS Serological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. RESULTS A total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in 2 that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or 2 vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. CONCLUSIONS The combination of molecular tests and the presence of specific IgG and IgM are necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.
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Affiliation(s)
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España
| | - M Victoria García-Rivera
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España
| | | | | | - Elena Román-Marcos
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España
| | - Fernando de Ory-Machón
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Juan Emilio Echevarría-Mayo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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24
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Kohnen M, Hoffmann P, Frisch C, Charpentier E, Sausy A, Hübschen JM. Diagnostic challenges and pockets of susceptibility identified during a measles outbreak, Luxembourg, 2019. ACTA ACUST UNITED AC 2021; 26. [PMID: 34085633 PMCID: PMC8176676 DOI: 10.2807/1560-7917.es.2021.26.22.2000012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Luxembourg was among the first countries in the World Health Organization (WHO) European Region documenting interruption of endemic measles transmission, but an increased incidence was registered in spring 2019. The outbreak started with an unvaccinated student who had been to a winter sports resort in a neighbouring country, where a measles outbreak was ongoing. Subsequently, 12 secondary and two tertiary cases were confirmed among students from the same school, relatives and healthcare workers, as well as six probably unrelated cases. Only 11 cases initially fulfilled the WHO definition for suspected measles cases. Fourteen of 20 cases with information on country of birth and the majority of unvaccinated cases (10/12) were born outside of Luxembourg. Measles IgM antibody results were available for 16 of the confirmed cases, and five of the eight IgM negative cases had been vaccinated at least once. All 21 cases were PCR positive, but for three previously vaccinated cases with multiple specimen types, at least one of these samples was negative. The outbreak highlighted diagnostic challenges from clinical and laboratory perspectives in a measles elimination setting and showed that people born abroad and commuters may represent important pockets of susceptible people in Luxembourg.
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Affiliation(s)
- Michel Kohnen
- Université Libre de Bruxelles, Brussels, Belgium.,Clinical laboratory, Centre Hospitalier de Luxembourg, Luxembourg, Grand Duchy of Luxembourg
| | - Patrick Hoffmann
- Health Directorate Luxembourg, Division de l'inspection sanitaire, Luxembourg, Grand Duchy of Luxembourg
| | - Caroline Frisch
- Health Directorate Luxembourg, Division de l'inspection sanitaire, Luxembourg, Grand Duchy of Luxembourg
| | - Emilie Charpentier
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand Duchy of Luxembourg
| | - Aurélie Sausy
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand Duchy of Luxembourg
| | - Judith M Hübschen
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Grand Duchy of Luxembourg
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25
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Colman S, Vernelen K, China B, Van den Bossche D, Cornelissen L, Delforge ML, Reynders M, Berth M, Depypere M, Van Gasse N, Vijgen S, Van Acker J, Boel A, Padalko E. Pitfalls of rubella serology while on the brink of elimination: evaluation of national data, Belgium, 2017. ACTA ACUST UNITED AC 2021; 26. [PMID: 34018485 PMCID: PMC8138961 DOI: 10.2807/1560-7917.es.2021.26.20.2000074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BackgroundIn Belgium, rubella serology is frequently requested in women of childbearing age, despite high vaccination coverage and a near-absence of congenital rubella cases. Different test kits are available and should be standardised by an international standard preparation.AimTo analyse and compare rubella serology practices in Belgian laboratories.MethodsAs part of the mandatory External Quality Assessment programme for rubella serology in Belgium, the national public health institute, Sciensano, sent a voluntary questionnaire concerning anti-rubella IgM/IgG analyses in women aged 15 to 45 years in 2017 to 130 laboratories.ResultsThe questionnaire response rate was 83.8% (109/130). The majority of 169,494 IgG analyses were performed on Roche (55%), Abbott (17%) and Diasorin (13%) analysers. Not all laboratories used the proposed international cut-off of 10 IU/mL. Assumed median seroprevalence ranged from 76.3% with Liaison (Diasorin) to 96.3% with Modular (Roche). Despite very low rubella incidence in Belgium, 93 laboratories performed 85,957 IgM analyses, with 748 positive and 394 grey zone results. The National Reference Centre for Measles, Mumps and Rubella virus and the National Reference Centre for Congenital infections did not confirm any positive rubella cases in 2017.ConclusionThis retrospective analysis shows that rubella serology results may differ considerably according to the assay used. It is therefore important to use the same test when comparing results or performing follow-up testing. The number of anti-rubella IgM analyses was very high. Incorrect use of IgM for screening women of childbearing age can lead to unwarranted anxiety and overuse of confirmation tests.
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Affiliation(s)
- Sofie Colman
- Clinical Laboratory of Microbiology, OLVZ Aalst, Aalst, Belgium
| | - Kris Vernelen
- Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Bernard China
- Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Dorien Van den Bossche
- Institute of Tropical Medicine, Antwerp, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | | | - Marie-Luce Delforge
- University Hospital Erasme, Brussels, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Marijke Reynders
- General Hospital Sint-Jan Bruges, Bruges, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Mario Berth
- General Hospital AZ Alma, Eeklo, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Melissa Depypere
- University Hospital Leuven, Leuven, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Natasja Van Gasse
- Hospital Network Antwerp, Antwerp, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Sara Vijgen
- General Hospital Jessa, Hasselt, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - Jos Van Acker
- General Hospital AZ Sint-Lucas, Ghent, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
| | - An Boel
- Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium.,Clinical Laboratory of Microbiology, OLVZ Aalst, Aalst, Belgium
| | - Elizaveta Padalko
- University Hospital Ghent, Ghent, Belgium.,Experts Committee EQA Infectious serology, Quality of Laboratories, Sciensano, Brussels, Belgium
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26
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Evaluation of Diagnostic Accuracy of Eight Commercial Assays for the Detection of Measles Virus-Specific IgM Antibodies. J Clin Microbiol 2021; 59:JCM.03161-20. [PMID: 33731415 PMCID: PMC8315954 DOI: 10.1128/jcm.03161-20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
The World Health Organization (WHO) has targeted measles for global eradication through mass immunization. For effective monitoring of eradication targets, high-quality surveillance is needed. The detection of IgM antibodies, specific to the measles virus, with the use of commercial enzyme-linked immunosorbent assays (ELISA or EIA) is broadly used within the WHO global measles and rubella laboratory network for laboratory confirmation, and in particular, ELISA kits manufactured by Siemens (Enzygnost kits) have been primarily used. Spurred by the discontinuation of these kits, this study aims to report on the clinical sensitivity and specificity of comparable commercial ELISA kits and one automated chemiluminescent immunoassay (CLIA) method. A panel of 239 serum samples was assembled that included sera from confirmed measles cases (n = 50) and probable post-MMR vaccine response (n = 2). Measles-negative sera (n = 187) were collected from individuals presenting with other fever and rash illnesses. A total of 7 ELISA kits (Euroimmun native antigens and recombinant nucleoprotein, IBL, Clin-Tech Microimmune, NovaTec NovaLisa, Serion, and Siemens Enzygnost) and one CLIA method (DiaSorin LIAISON XL) were evaluated. The ELISA kits included two IgM capture methods and five indirect methods. Calculated sensitivities and specificities ranged from 75.0% to 98.1% and 86.6% to 99.5%, respectively. The parvovirus B19 IgM positive sera were noted to cause false-positive results, particularly for the ELISA kits from Serion and NovaLisa; specificities for this subset of samples ranged from 51.4% to 100.0%. The capture IgM ELISA methods provided the best combination of sensitivity and specificity.
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27
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Ogata T, Murooka M, Akashi M, Ishitsuka A, Miyazaki A, Osawa S, Ishikawa K, Tanaka-Taya K, Uehara R. The period from prodromal fever onset to rash onset in laboratory-confirmed rubella cases: a cross-sectional study. BMC Infect Dis 2021; 21:442. [PMID: 33992076 PMCID: PMC8122568 DOI: 10.1186/s12879-021-06158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
Background In resource-limited settings, where rubella is endemic, it is difficult to determine which sporadic case should be tested for rubella. The study aimed to provide useful evidence to help screen rubella cases for real-time reverse transcriptase-polymerase chain reaction (RT-PCR) examination for rubella in resource-limited settings. Method Suspected rubella patients identified by a physician and brought to the notice of the Ryugasaki public health center or the Tsuchiura public health center were enrolled from April 2018 through December 2019. The inclusion criterion was a confirmed rubella diagnosis based on laboratory tests. We studied the distribution of the time from the onset of fever until the onset of rash. Results The study included 86 cases with simultaneous presentation of fever and rash. Twenty-nine cases had confirmed rubella based on the laboratory diagnosis. Among these, the time from the onset of fever until the onset of rash was limited to − 1 day to 2 days. The number of rubella cases was the highest when the onset of rash was on the following day of the onset of fever. Of the 78 patients who underwent the RT-PCR test, 48% tested positive for rubella among those with a time from the onset of fever to the onset of rash between − 1 day and 2 days (22 out of 46, 95% confidence interval 34–62%); no positive results (0 out of 30, 95% confidence interval - 14%) were seen in patients with a time from fever to rash onset ≥3 days. Conclusion The period from the onset of fever to the onset of rash was limited to − 1 day to 2 days among confirmed rubella patients. If the period from onset of fever to the onset of rash was ≥3 days for a patient, the likelihood of rubella was low.
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Affiliation(s)
- Tsuyoshi Ogata
- Itako Public Health Center of Ibaraki Prefectural Government, Itako, 311-2422, Japan.
| | - Maki Murooka
- Ryugasaki Public Health Center of Ibaraki Prefectural Government, Ryugasaki, 301-0822, Japan
| | - Makoto Akashi
- Ryugasaki Public Health Center of Ibaraki Prefectural Government, Ryugasaki, 301-0822, Japan
| | - Akemi Ishitsuka
- Ryugasaki Public Health Center of Ibaraki Prefectural Government, Ryugasaki, 301-0822, Japan
| | - Akari Miyazaki
- Tsuchiura Public Health Center of Ibaraki Prefectural Government, Tsuchiura, 300-0812, Japan
| | - Shuuichi Osawa
- Ibaraki Prefectural Institute of Public Health of Ibaraki Prefectural Government, Mito, 310-0852, Japan
| | - Kanako Ishikawa
- Ibaraki Prefectural Institute of Public Health of Ibaraki Prefectural Government, Mito, 310-0852, Japan
| | | | - Ritei Uehara
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, 602-8566, Japan
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28
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Performance of Four IgM Antibody Assays in the Diagnosis of Measles Virus Primary Infection and Cases with a Serological Profile Indicating Reinfection. J Clin Microbiol 2021; 59:JCM.02047-20. [PMID: 33627321 PMCID: PMC8091831 DOI: 10.1128/jcm.02047-20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/21/2021] [Indexed: 12/25/2022] Open
Abstract
The object of this study was to determine the diagnostic performance of four commercially available IgM tests in the diagnosis of measles virus (MeV) primary infection and cases with a serological profile indicating reinfection. Sera from 187 patients with MeV primary infection, 30 patients with suspected reinfection (after vaccine failure), and 153 patients with rash-like symptoms after exclusion of MeV infection were retested with four IgM tests. The object of this study was to determine the diagnostic performance of four commercially available IgM tests in the diagnosis of measles virus (MeV) primary infection and cases with a serological profile indicating reinfection. Sera from 187 patients with MeV primary infection, 30 patients with suspected reinfection (after vaccine failure), and 153 patients with rash-like symptoms after exclusion of MeV infection were retested with four IgM tests. MeV infection was verified by reverse transcriptase PCR (RT-PCR), and primary and suspected reinfections were differentiated by IgG avidity and neutralization assays. All IgM assays displayed significant agreement (Cohen’s κ, ≥0.604; all P < 0.001) and a higher diagnostic accuracy in primary infection than in suspected reinfection (indicated by high IgG avidity and significantly higher anti-MeV-IgG and neutralizing titers). In the overall cohort, the areas under the curve (AUC) were comparable among all tests, ranging from 0.875 to 0.931, with ranges increasing to 0.911 to 0.930 in the primary infection and decreasing to 0.765 to 0.940 in the setting of high anti-MeV-IgG avidity, and all tests displayed high specificity (81.1 to 92.2%). Of note, IgM tests with the highest diagnostic accuracy had discriminatory abilities not significantly different than PCR from serum. Although reinfections pose a challenge for IgM testing, IgM assays remain a cornerstone in the diagnosis of MeV infections. Especially in samples with a serological profile indicating reinfections, IgM tests displayed an equal or even superior diagnostic ability compared to PCR from serum.
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29
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Adekola HA, Abdullahi IN, Emeribe AU, Faruku N, Uzairue L, Adeyemi Billyrose OM, Shuwa HA. Sero-survey of measles virus antibodies among symptomatic children attending Abuja Teaching Hospital, Nigeria. GMS HYGIENE AND INFECTION CONTROL 2021; 16:Doc04. [PMID: 33643771 PMCID: PMC7894129 DOI: 10.3205/dgkh000375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Nigeria is one of the countries with a high prevalence of measles outbreak in children under 5 years old, despite a history of vaccination. This study aims to determine the prevalence of anti-measles virus IgM and IgG among children under 5 years attending the University of Abuja Teaching Hospital (UATH), Gwagwalada, FCT Abuja, Nigeria. Materials and methods: Whole blood was collected, centrifuged, and serum anti-IgM and anti-IgG against measles virus was analysed using ELISA. Sociodemographic variables and vaccination history of subjects were obtained by interview-based questionnaires. Results: The overall anti-Measles virus IgG and IgM seroprevalences were 29.2% and 14.6%, respectively. The prevalence of measles IgG was significantly associated with the parent’s employment status (X2=11.67, p=0.008). However, the prevalence of measles virus IgM was significantly associated with children’s age (X2=16.62, p=0.002), parents’ employment status and children’s vaccination status (X2 =7.72, p=0.02). Conclusion: A majority of study participants were not immunised against measles, and a significant number of participants had serological evidence of acute measles virus infection. There is a need for more concerted and massive measles vaccination of children.
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Affiliation(s)
| | - Idris Nasir Abdullahi
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Anthony Uchenna Emeribe
- Department of Medical Laboratory Science, Faculty of Allied Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Nafiu Faruku
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Leonard Uzairue
- Department of Microbiology, Federal University of Agriculture, Abeokuta, Nigeria
| | | | - Halima Ali Shuwa
- University Health Center, Faculty of Health and Medical Sciences, Federal University, Dutse, Nigeria
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30
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Larenas-Linnemann D, Luna-Pech J, Navarrete-Rodríguez EM, Rodríguez-Pérez N, Arias-Cruz A, Blandón-Vijil MV, Del Rio-Navarro BE, Estrada-Cardona A, Onuma-Takane E, Pozo-Beltrán CF, Valencia-Herrera AM, Ortiz-Aldana FI, Toledo-Bahena ME. Cutaneous Manifestations Related to COVID-19 Immune Dysregulation in the Pediatric Age Group. Curr Allergy Asthma Rep 2021; 21:13. [PMID: 33630167 PMCID: PMC7905763 DOI: 10.1007/s11882-020-00986-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 01/04/2023]
Abstract
Purpose of Review At the juncture of the COVID-19 pandemic, the world is currently in an early phase of collecting clinical data and reports of its skin manifestations, and its pathophysiology is still highly conjectural. We reviewed cutaneous manifestations associated with COVID-19 in the pediatric age group. Recent Findings Children infected by SARS-CoV-2 usually develop milder respiratory symptoms, but cutaneous manifestations seem a little more prevalent than in adults. These skin features of infection by the coronavirus can be similar to those produced by other common viruses, but there are also reports of cases with more heterogeneous clinical pictures, which have made their classification difficult. To date, the more frequently reported skin variants featured in pediatric cases are purpuric (pseudo-chilblain, necrotic-acral ischemia, hemorrhagic macules, and/or cutaneous necrosis), morbilliform/maculopapular, erythema multiforme, urticarial, vesicular, Kawasaki-like, and miscellaneous (highly variable in both frequency and severity). Their pathophysiological mechanism is still elusive and is likely to be the result of the complex involvement of one or more mechanisms, like direct virus-induced skin damage, vasculitis-like reactions, and/or indirect injury as a consequence of a systemic inflammatory reaction. Summary In this review, we presented and discussed clinical cases as examples of different cutaneous responses reported in some children with SARS-CoV-2 infection, differential diagnosis considerations, and a preliminary conceptual approach to some of their probable associated pathologic mechanisms.
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Affiliation(s)
- Désirée Larenas-Linnemann
- Médica Sur Fundación Clínica y Hospital, Mexico City, Mexico
- Hospital Médica Sur, Torre 2, cons. Puente de piedra 150, T2-602 Toriello-Guerra; delegación Tlalpan, Mexico City, Mexico
| | - Jorge Luna-Pech
- Departamento de Disciplinas Filosóficas Metodoloógicas e Instrumentales, Universidad de Guadalajara, Guadalajara, Jalisco Mexico
| | | | - Noel Rodríguez-Pérez
- Consulta Privada, Universidad Autónoma de Tamaulipas, Matamoros, Tamaulipas Mexico
| | - Alfredo Arias-Cruz
- Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Blanca E. Del Rio-Navarro
- Servicio de Alergia e Inmunología Clínica, Hospital Infantil de Mexico Federico Gómez, Mexico City, Mexico
| | | | | | - Cesar Fireth Pozo-Beltrán
- Subdirección de Enseñanza e Investigación, Hospital General de Especialidades Juan María Salvatierra, La Paz, Baja California Sur Mexico
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31
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Fortuny LR, Cabler SS, Hunstad DA, Yarbrough ML. Blueberry Muffin Rash, Bilateral Cataracts, and Thrombocytopenia in a Neonate. Clin Chem 2021; 67:472-475. [PMID: 33674845 DOI: 10.1093/clinchem/hvaa310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Lisandro R Fortuny
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Stephanie S Cabler
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - David A Hunstad
- Division of Infectious Diseases, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Melanie L Yarbrough
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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32
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Broadhurst MJ, Garamani N, Hahn Z, Jiang B, Weber J, Huang C, Sahoo MK, Kurzer J, Hogan CA, Pinsky BA. Evaluation of a measles virus multiplex, triple-target real-time RT-PCR in three specimen matrices at a U.S. academic medical center. J Clin Virol 2021; 136:104757. [PMID: 33639409 DOI: 10.1016/j.jcv.2021.104757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Measles virus (MeV) is an important cause of acute febrile illness and pediatric mortality globally, with recent U.S. outbreaks associated with under-vaccination. MeV is highly contagious and timely diagnosis is critical to limit spread. RNA detection is the most sensitive method for acute measles diagnosis; however, MeV nucleic acid amplification assays are not widely available. METHODS We performed a diagnostic accuracy study of a triple-target, real-time RT-PCR (rRT-PCR) assay for simultaneous detection of MeV N, H, and L genes. RESULTS The MeV triple-target rRT-PCR was tested against serial dilutions (7.0-2.0 log10 copies/mL) of five MeV isolates representing circulating genotypes, and detected 98.7% (74/75) of nasopharyngeal (NP) swab dilutions, 100% (75/75) of plasma dilutions, and 85.3% (64/75) of urine dilutions. MeV RNA detection in urine was markedly improved with the addition of a nucleic acid stabilizing agent. A 95% lower limit of detection (LLOD) of < 3.0 log10 copies/mL was established in each specimen matrix. No cross-reactivity with relevant viruses or interfering substances were identified in specificity studies. The MeV triple-target rRT-PCR detected all three gene targets in a clinical NP swab from an individual with confirmed measles infection. Furthermore, pooled testing from 798 influenza A/B/RSV-negative pediatric NP swabs identified two specimens positive for MeV RNA, confirmed by N gene sequencing to represent shedding of the vaccine-type measles virus. CONCLUSIONS The MeV triple-target rRT-PCR assay showed high analytic sensitivity across circulating MeV genotypes in three clinically-relevant matrices. Implementation of this assay in the clinical laboratory may facilitate timely diagnosis of acute measles infection and implementation of appropriate infection control interventions.
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Affiliation(s)
- M Jana Broadhurst
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States
| | - Natasha Garamani
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States
| | - Zoe Hahn
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States
| | - Becky Jiang
- Clinical Virology Laboratory, Stanford Health Care, California, United States
| | - Jenna Weber
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States
| | - ChunHong Huang
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States
| | - Malaya K Sahoo
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States
| | - Jason Kurzer
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States
| | - Catherine A Hogan
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States; Clinical Virology Laboratory, Stanford Health Care, California, United States
| | - Benjamin A Pinsky
- Department of Pathology, Stanford University School of Medicine, Stanford, California, United States; Clinical Virology Laboratory, Stanford Health Care, California, United States; Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, United States.
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Gibney KB, Attwood LO, Nicholson S, Tran T, Druce J, Healy J, Strachan J, Franklin L, Hall R, Cross GB. Emergence of Attenuated Measles Illness Among IgG-positive/IgM-negative Measles Cases: Victoria, Australia, 2008-2017. Clin Infect Dis 2021; 70:1060-1067. [PMID: 31056637 DOI: 10.1093/cid/ciz363] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Waning measles immunity among vaccinated individuals may result in an attenuated illness. This study compares the epidemiological, clinical, and laboratory profile of measles cases with waning immunity with other measles cases. METHODS Polymerase chain reaction-positive (+) measles cases notified to Victoria's Department of Health and Human Services from 2008 to 2017 with immunoglobulin (Ig) M and IgG tested at diagnosis were classified according to serology at diagnosis: IgG negative (-) (nonimmune), IgM+/IgG+ (indeterminate), or IgM-/IgG+ (waning immunity). RESULTS Between 2008 and 2017, 297 measles cases were notified, of whom 190 (64%) were included; 151 of 190 (79%) were nonimmune at diagnosis, 26 (14%) were indeterminate, and 13 (7%) had waning immunity. Between 2008-2013 and 2014-2017, the proportion of cases with waning immunity increased from 0 of 87 (0%) to 13 of 103 (13%) (P < .001) and the diagnostic sensitivity of initial IgM fell from 93% to 81% (P = .012), respectively. Seven (54%) waning immunity cases reported receiving measles-containing vaccines; 1 case had 2 documented doses. Compared with nonimmune and indeterminate cases, waning immunity cases were more likely to be male; less likely to report fever, coryza, and cough; and had lower burden of virus (higher cycle threshold values). Waning immunity cases had higher IgG titers than indeterminate cases (mean optical density values, 1.96 vs 0.71; P = .004). Onward transmission from 1 waning immunity case was documented. CONCLUSIONS Waning immunity among measles cases, associated with secondary vaccine failure and modified clinical illness, is emerging in Victoria with transmission potential.
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Affiliation(s)
- Katherine B Gibney
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia.,The Peter Doherty Institute for Infection and Immunity, the University of Melbourne and the Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Lucy O Attwood
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Thomas Tran
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Julian Druce
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Julia Healy
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Janet Strachan
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Lucinda Franklin
- Health Protection Branch, Victorian Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Robert Hall
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gail B Cross
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Department of Infectious Diseases, National University Hospital, Singapore
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Wang Q, Pu G, Tang G, Lu X, Wang G, Du Q, Zhang G, Guo X. Mechanism of heparin interference in detection of LIAISON® Rubella IgM. Clin Chim Acta 2020; 511:7-13. [PMID: 32950518 DOI: 10.1016/j.cca.2020.09.021] [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: 08/26/2020] [Accepted: 09/15/2020] [Indexed: 11/16/2022]
Abstract
AIMS To investigate the effects of heparin in detection of LIAISON® Rubella IgM (Rub-M) and the mechanism of interference. METHODS Different concentrations of lithium heparin and sodium heparin were added to ten serum samples. The relative light units (RLU) value of Rub-M was measured using the LIAISON XL detection system. Different levels of IgM serum were incubated with magnetic particle in Rub-M detection kit at 4 °C for 4 h, blocking anti-human IgM-specific antibodies coated on the surface of magnetic particle. Separately, the rubella virus antigen in Rub-M detection kit was replaced by phosphate-buffered saline (PBS). The RLU values of LIAISON® Rub-M of original serum and serum containing various concentrations of heparin were measured after the above two different treatments. RESULTS The RLU value of LIAISON® Rub-M increased with the increase of heparin content lower than 40 IU/mL, and reached a peak value at 40-50 IU/mL. The RLU value of LIAISON® Rub-M then decreased with the decrease of heparin concentration. When rubella virus antigen was replaced by PBS, the RLU value of LIAISON® Rub-M of serum samples containing 40 IU/mL heparin decreased significantly. The blocking concentration of IgM increased gradually, and the RLU value of LIAISON® Rub-M of seven serum samples containing 40 IU/mL heparin also decreased gradually. CONCLUSION Plasma with heparin cannot be used to the detection of LIAISON® Rub-M. Heparin may participate in the reaction by binding with rubella virus antigen and anti-human IgM-specific antibodies coated on the surface of magnetic particle, thus affecting the detection results.
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Affiliation(s)
- Qiang Wang
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, China; Translational Medicine Research Center, North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Guihong Pu
- Department of Laboratory Medicine, Leshan Hospital of Traditional Chinese Medicine, Leshan, Sichuan 614000, China
| | - Guohui Tang
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Xiaolan Lu
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, China; Translational Medicine Research Center, North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Gangrong Wang
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, China; Translational Medicine Research Center, North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Qin Du
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, China; Translational Medicine Research Center, North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Guoyuan Zhang
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, China; Translational Medicine Research Center, North Sichuan Medical College, Nanchong, Sichuan 637000, China
| | - Xiaolan Guo
- Department of Laboratory Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, China; Department of Laboratory Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, China; Translational Medicine Research Center, North Sichuan Medical College, Nanchong, Sichuan 637000, China.
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Lazar M, Stănescu A, Penedos AR, Pistol A. Characterisation of measles after the introduction of the combined measles-mumps-rubella (MMR) vaccine in 2004 with focus on the laboratory data, 2016 to 2019 outbreak, Romania. ACTA ACUST UNITED AC 2020; 24. [PMID: 31339098 PMCID: PMC6652110 DOI: 10.2807/1560-7917.es.2019.24.29.1900041] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Since January 2016, a resurgence of measles in Romania has led to the third measles epidemic in the past 12 years; 64 deaths have been confirmed so far–the highest number of measles-related deaths since the measles-mumps-rubella (MMR) vaccine was introduced in 2004. Aim To provide an overview on the characterisation on measles in Romania after the introduction of the MMR vaccine with focus on the current outbreak, laboratory and molecular analysis. Methods We performed an analysis of measles incidence and mortality after the introduction of MMR vaccination and a retrospective study using serological and molecular data in three consecutive outbreaks with focus on the current outbreak. Results In the current outbreak, 17,533 measles cases were notified to the national surveillance system, 93% were unvaccinated. Measles virus was isolated from 429 samples and 283 were genotyped. Genotype B3 was predominant (n = 269) and sporadic measles cases associated with D8 genotype (n = 9) were also observed; genotype D4 and D8 were identified in the previous two measles outbreaks. The detection of several distinct measles virus B3 genotypes suggests multiple virus importations to Romania. Conclusion The current outbreak is a consequence of insufficient vaccine coverage. Control measures were implemented to improve uptake of MMR vaccine, including administering the first MMR dose at a younger age (9–11 months) and offering catch-up vaccination to children that have not followed the recommended dosing schedule. More measures are needed to improve the surveillance performance and to achieve high routine MMR vaccination coverage.
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Affiliation(s)
- Mihaela Lazar
- Research Institute of the University of Bucharest (ICUB), Earth Environmental and Life Sciences Division, Bucharest, Romania.,Cantacuzino, National Military-Medical Institute for Research and Development, Bucharest, Romania
| | - Aurora Stănescu
- National Centre for Communicable Diseases Surveillance and Control, National Institute of Public Health, Bucharest, Romania
| | - Ana Raquel Penedos
- Virus Reference Department, Public Health England, London, United Kingdom
| | - Adriana Pistol
- National Centre for Communicable Diseases Surveillance and Control, National Institute of Public Health, Bucharest, Romania
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Pérez Olmeda M, Balfagón P, Camacho J, Dafouz D, de la Fuente J, Murillo MÁ, Muñoz JL, Fernández García A, Sanz JC, de Ory F. Comparative evaluation of assays for IgM detection of rubella and measles infections. Enferm Infecc Microbiol Clin 2020; 40:S0213-005X(20)30256-1. [PMID: 32828554 DOI: 10.1016/j.eimc.2020.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Serological diagnosis of infections due to measles and rubella viruses is done by IgM detection. The aim of this study was to comparatively evaluate commercial systems for detecting IgM against both viruses, including those of ELISA, in indirect and capture formats, chemiluminescence and electrochemiluminescence. METHODS Seven (for rubella) and six (for measles) assays were studied. One hundred and sixty two samples were included in the study (from 90 rubella and 72 measles cases), and all were analyzed in all the assays. RESULTS The ranges of sensitivity, specificity and agreement for rubella were 94.8-100%, 52.4-100% and 75.5-98.1%, respectively. The corresponding ranges for measles assays were 87.0-100%, 53.3-100%, and 73.0-99.4%. CONCLUSION The best-performing assays were chemiluminescence (for measles and rubella IgM), and electrochemiluminescence (for rubella IgM).
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Affiliation(s)
- Mayte Pérez Olmeda
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Pilar Balfagón
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Juan Camacho
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Desirée Dafouz
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Jesús de la Fuente
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - María Ángeles Murillo
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - José Luis Muñoz
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Aurora Fernández García
- Laboratorio de Aislamiento Viral, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CiberESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos Sanz
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CiberESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando de Ory
- Laboratorio de Serología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Spain; Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública (CiberESP), Instituto de Salud Carlos III, Madrid, Spain.
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Dunn JJ, Baldanti F, Puchhammer E, Panning M, Perez O, Harvala H. Measles is Back - Considerations for laboratory diagnosis. J Clin Virol 2020; 128:104430. [PMID: 32454430 DOI: 10.1016/j.jcv.2020.104430] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/04/2020] [Accepted: 05/09/2020] [Indexed: 10/24/2022]
Abstract
Measles is a highly contagious viral illness that continues to cause significant mortality among young children worldwide despite the availability of a safe and effective vaccine. During the first half of 2019, over 182 countries reported more than 300,000 measles cases; greater than double the number from the same period in 2018. Timely recognition and laboratory confirmation of infected individuals as well as appropriate infection prevention measures are crucial to avert further transmission. This review highlights the importance of early recognition of the signs and symptoms of measles and provides details on the laboratory methods commonly employed to confirm cases, investigate outbreaks and characterize the virus. It's critical that clinicians, laboratorians and public health administrations work together to rapidly identify, confirm and contain the spread of measles globally.
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Affiliation(s)
- J J Dunn
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA; Department of Pathology, Texas Children's Hospital, Houston, TX, USA.
| | - F Baldanti
- Molecular Virology Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - E Puchhammer
- Center for Virology, Medical University Vienna, Austria
| | - M Panning
- Department of Medicine, Institute for Virology, University of Freiburg, Germany
| | - O Perez
- Department of Pathology, University of Illinois at Chicago College of Medicine, USA
| | - H Harvala
- Department of Infection, University College of London, London, UK; National Microbiology Services, NHS Blood and Transplant, London, UK
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Brown DW, Warrener L, Scobie HM, Donadel M, Waku-Kouomou D, Mulders MN, Rota PA. Rapid diagnostic tests to address challenges for global measles surveillance. Curr Opin Virol 2020; 41:77-84. [PMID: 32615510 PMCID: PMC7492366 DOI: 10.1016/j.coviro.2020.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 12/13/2022]
Abstract
Recently, a lateral flow rapid diagnostic test (RDT) with good accuracy has been described. This test enables measles specific IgM antibody detection in serum, capillary blood and oral fluid. RDTs have the potential to transform measles surveillance by allowing real-time case confirmation outside of central/regional laboratories and by facilitating a timely public health response. Measles virus genes can also be amplified and sequenced consistently from dried IgM-positive RDTs stored outside of cold chain, which will enable more complete virologic surveillance. Critical questions remain regarding operational use of RDTs as part of global measles surveillance. Projects to evaluate RDT use as part of national surveillance programs and to commercialize the RDT are underway.
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Affiliation(s)
- David W Brown
- Virus Reference Department, National Infection Service, Public Health England, London, UK; Laboratório de Vírus Respiratórios e do Sarampo, Instituto Oswaldo Cruz/Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Lenesha Warrener
- Virus Reference Department, National Infection Service, Public Health England, London, UK
| | - Heather M Scobie
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Morgane Donadel
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Mick N Mulders
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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BIANCHI S, FACCINI M, LAMBERTI A, SENATORE S, CICERI G, FRATI E, COLZANI D, GORI M, CEREDA D, GRAMEGNA M, AUXILIA F, TANZI E, AMENDOLA A. Measles surveillance activities in the Metropolitan Area of Milan during 2017-2018. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 60:E286-E292. [PMID: 31967085 PMCID: PMC6953458 DOI: 10.15167/2421-4248/jpmh2019.60.4.1269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/02/2019] [Indexed: 11/28/2022]
Abstract
Introduction In Italy, the transmission of measles is still endemic, and 7,919 cases were reported to the National Surveillance System between January 2017 and December 2018. Aim of this study is to report the results of the measles surveillance activities in the Metropolitan City of Milan from March 2017 to December 2018, and to evaluate the surveillance performance WHO indicators. Methods The Local Health Units (LHUs) carried out case investigations and collected specimens to send to the EpiSoMI Lab (Subnational Reference Laboratory, SRL) of the University of Milan for cases/outbreaks confirmation and genotyping performed according to the WHO Guidelines. Results Overall, 610 suspected measles cases were reported by the surveillance system of the Metropolitan City of Milan. A total of 439 out of 540 cases with adequate specimens were laboratory-confirmed by molecular and/or serological assays. Two-hundred and thirty-six cases were notified as sporadic and 203 as related to 94 outbreaks. The most confirmed cases were aged 15–39 years, almost all not vaccinated. Overall, 282 cases were genotype D8 and 118 genotype B3. The evaluation of a set of indicators to monitor the quality of surveillance activities demonstrated the proficiency of the EpiSoMI Lab. Conclusions A well-done investigation of cases and outbreaks by the surveillance local system, in a timely manner, in order to notify and investigate suspected cases and to laboratory confirm or discard cases is fundamental to reduce morbidity, to prevent further virus transmission and to achieve measles elimination.
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Affiliation(s)
- S. BIANCHI
- Department of Biomedical Sciences for Health, University of Milan, Italy
- Correspondence: Silvia Bianchi, Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy - Tel. +39 02 50315122 - Fax +39 02 50315120 - E-mail:
| | - M. FACCINI
- Health Protection Agency, Metropolitan Area of Milan, Italy
| | - A. LAMBERTI
- Health Protection Agency, Metropolitan Area of Milan, Italy
| | - S. SENATORE
- Health Protection Agency, Metropolitan Area of Milan, Italy
- DG Welfare, UO Prevenzione, Lombardy Region, Milan, Italy
| | - G. CICERI
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - E.R. FRATI
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - D. COLZANI
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - M. GORI
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - D. CEREDA
- DG Welfare, UO Prevenzione, Lombardy Region, Milan, Italy
| | - M. GRAMEGNA
- DG Welfare, UO Prevenzione, Lombardy Region, Milan, Italy
| | - F. AUXILIA
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - E. TANZI
- Department of Biomedical Sciences for Health, University of Milan, Italy
- Coordinated Research Center “EpiSoMI”, University of Milan, Italy
- CIRI-IV, Department of Health Sciences, University of Genoa, Italy
| | - A. AMENDOLA
- Department of Biomedical Sciences for Health, University of Milan, Italy
- Coordinated Research Center “EpiSoMI”, University of Milan, Italy
- CIRI-IV, Department of Health Sciences, University of Genoa, Italy
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Husada D, Kusdwijono, Puspitasari D, Kartina L, Basuki PS, Ismoedijanto. An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting. BMC Pediatr 2020; 20:5. [PMID: 31906914 PMCID: PMC6943953 DOI: 10.1186/s12887-020-1908-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/31/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Measles is a recurrent health problem in both advanced and developed countries. The World Health Organization (WHO) recommends anti-measles immunoglobulin M (Ig M) as the standard method of detecting the virus; however, many areas still present the inability to perform a serology test of anti-measles IgM. Therefore, a typical clinical feature is necessary to establish the diagnosis of measles. The objective of this study was to evaluate hyperpigmented rash and other clinical features as the diagnostic tools with respect to measles, especially in an outbreak setting. METHODS In this observational diagnostic study, the inclusion criteria were as follows: between 6 and 144 months of age, fever, maculopapular rash for 3 days or more, accompanied by a cough, or coryza, or conjunctivitis. Those with a prior history of measles vaccination (1-6 weeks) were excluded, in addition to those with histories of corticosteroid for 2 weeks or more and immunocompromised conditions. The samples were taken from Dr. Soetomo General Academic Hospital in Surabaya, Indonesia. We evaluated the sensitivity, specificity, the positive predictive value, and the negative predictive value of such clinical features. Hyperpigmented rash was validated using Kappa and Mc Nemar tests. Anti-measles Ig M was considered as the gold standard. RESULTS This study gathered 82 participants. The clinical manifestations of all subjects included fever, cough, coryza, conjunctivitis, Koplik spots, and maculopapular rash (which turns into hyperpigmented rash along the course of the illness). Most maculopapular rashes turn out to be hyperpigmented (89%). Sensitivity, specificity, positive predictive value, and negative predictive values of the combination of fever, maculopapular rash, and hyperpigmented rash were found to be at 90.7, 28.6, 93.2, and 22.2%, respectively. The Mc Nemar and Kappa tests showed p values of 0.774 and 0.119, respectively. CONCLUSION The combination of fever, maculopapular rash, and hyperpigmented rash can be used as a screening tool regarding measles infection in an outbreak setting, which can then be confirmed by anti-measles Ig M. Cough, coryza, and Koplik's spot can be added to this combination, albeit with a slight reduction of sensitivity value.
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Affiliation(s)
- Dominicus Husada
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Kusdwijono
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Dwiyanti Puspitasari
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Leny Kartina
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Parwati Setiono Basuki
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
| | - Ismoedijanto
- Department of Child Health, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General Academic Hospital, Surabaya, 60286 Indonesia
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Uchino K, Miyoshi T, Mori Y, Komase K, Okayama F, Shibata Y, Yoshida H, Numata T, Takeda M, Tanaka T. Comparison of virological and serological methods for laboratory confirmation of rubella. J Clin Virol 2019; 123:104257. [PMID: 31927348 DOI: 10.1016/j.jcv.2019.104257] [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: 05/30/2019] [Revised: 11/01/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Work toward rubella elimination has accelerated globally. A reliable laboratory confirmation of rubella-suspected cases is required for effective surveillance in the rubella-elimination phase. The use of adequate specimens is a key to improving the quality of this surveillance. STUDY DESIGN We conducted rubella virus (RUBV) isolation and RUBV genome or anti-RUBV IgM detection on 1023 specimens from 372 rubella- or measles-suspected cases collected through the national surveillance program in Sakai city of Osaka prefecture, Japan between 2011 and 2013. The resulting data were analyzed by specimen type, collection date, and immunological status. RESULTS Among the three specimen types (throat swab, serum or plasma, and urine) collected through 10 days post-rash onset, the highest success rates for RUBV genome detection and RUBV isolation were obtained using throat swabs. In agreement with previous work, RUBV-specific IgM were undetectable in 50% of the rubella-confirmed cases until 3 days after rash onset. The success rates of RUBV genome detection and RUBV isolation declined in association with the appearance of RUBV-specific antibodies in blood, especially in serum, plasma, or urine samples. CONCLUSION Throat swabs are the most optimal specimen types for both RUBV genome detection and RUBV isolation; serum/plasma samples may be suboptimal, especially for RUBV isolation. The findings from this study will provide useful information for improving laboratory surveillance for rubella in the elimination phase.
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Affiliation(s)
- Kiyoko Uchino
- Sakai City Institute of Public Health, 3-2-8 Kaicho-Higashi, Sakai, Osaka, 590-0953, Japan
| | - Tatsuya Miyoshi
- Sakai City Institute of Public Health, 3-2-8 Kaicho-Higashi, Sakai, Osaka, 590-0953, Japan
| | - Yoshio Mori
- Department of Virology 3, National Institute of Infectious Diseases, 4-7-1 Musashimurayama, Tokyo, 208-0011, Japan
| | - Katsuhiro Komase
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Sinjuku-ku, Tokyo, 162-8640, Japan
| | - Fumika Okayama
- Sakai City Institute of Public Health, 3-2-8 Kaicho-Higashi, Sakai, Osaka, 590-0953, Japan
| | - Yuri Shibata
- Sakai City Institute of Public Health, 3-2-8 Kaicho-Higashi, Sakai, Osaka, 590-0953, Japan
| | - Hisayoshi Yoshida
- Sakai City Institute of Public Health, 3-2-8 Kaicho-Higashi, Sakai, Osaka, 590-0953, Japan
| | - Tomizo Numata
- Sakai City Institute of Public Health, 3-2-8 Kaicho-Higashi, Sakai, Osaka, 590-0953, Japan
| | - Makoto Takeda
- Department of Virology 3, National Institute of Infectious Diseases, 4-7-1 Musashimurayama, Tokyo, 208-0011, Japan
| | - Tomoyuki Tanaka
- Sakai City Institute of Public Health, 3-2-8 Kaicho-Higashi, Sakai, Osaka, 590-0953, Japan.
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Samaraweera B, Mahanama A, Ahamad AZ, Wimalaratne GI, Abeynayake J. The laboratory investigation of a measles outbreak in the eve of its elimination in Sri Lanka. J Clin Virol 2019; 122:104230. [PMID: 31821951 DOI: 10.1016/j.jcv.2019.104230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Measles is highly contagious and cause significant morbidity and mortality. Sri-Lanka has the goal to eliminate endogenous measles by 2020 in par with WHO. OBJECTIVE To describe laboratory confirmation and genotype distribution of measles cases during the outbreak occurred from mid-March to May 2019, Sri-Lanka STUDY DESIGN: This retrospective study was conducted at National Measles Reference Laboratory (NMRL), Sri-Lanka. All samples received were tested according to the testing flow chart at NMRL with WHO recommended kits. Blood samples were tested for anti-measles IgM and IgG with IgG avidity for IgG positives. Samples within 5days post-onset rash were tested with measles real-time RT-PCR. Products of genotyping PCR were sent to Regional Reference Laboratory, Thailand for sequencing. Subsequent phylogenetic analysis was done at NMRL. Data were analyzed by descriptive statistics. RESULTS A total of 182 blood and 46 throat/nasopharyngeal swabs were received from 195 suspected cases and 37(19 %) were positive for measles by anti-measles IgM, rRT-PCR or both. Majority was females, with mean age of 20 years. Cases represented three main geographical areas; Western-35 %, Central-32 % and Southern-27 %. High avidity IgG was detected in 27/37(73 %). Sequencing data of six cases (4 from Western and 2 from Central province) revealed genotype D8. CONCLUSION Nineteen percent of the suspected patients were measles positive with 73 % having re-infections. Majority were 22 years or over. Measles genotype was D8 in two provinces, suggesting the spread of virus within the country. Laboratory confirmation with measles PCR; IgG avidity and sequencing/genetic analysis is critical in the verge of measles elimination.
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Sanz JC, Vadillo I, Gómez T, Echevarría JE, Fernández A, de Ory F. Caracterización de los resultados correspondientes al brote de sarampión de Madrid de 2019 en las muestras clínicas procesadas en el Laboratorio Regional de Salud Pública. REVISTA MADRILEÑA DE SALUD PÚBLICA 2019. [DOI: 10.36300/remasp.2019.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
En la primavera de 2019 se ha producido en la Comunidad de Madrid un aumento de casos de sarampión. El objetivo de este estudio es describir el tipo de muestras clínicas estudiadas y los resultados obtenidos en este brote.
Entre el 1 de abril y el 25 de junio de 2019 se procesaron 193 muestras biológicas correspondientes a 109 sospechas clínicas de sarampión. Las determinaciones serológicas (IgM e IgG frente a sarampión y rubéola) se llevaron a cabo por ELISA indirecto. La amplificación de ácidos nucleicos de los virus del sarampión y la rubéola se efectuó mediante RT-PCR.
Se confirmaron 44 casos de sarampión. Dos de ellos habían sido vacunados muy recientemente y ambos presentaban el genotipo vacunal A. Los amplificados de todas las cepas salvajes (21) eran D8. En esta serie, el tiempo medio observado entre recepción de muestras y obtención del resultado positivo fue de 0,5 días. En 32 casos confirmados se dispuso de muestras tanto de exudado faríngeo para RT-PCR como de sangre para serología y en 32 la RT-PCR resultó positiva (sensibilidad 100%, IC95% 86,7- 99,7) mientras que en 22 la IgM fue positiva (sensibilidad 68,8%, IC95% 49,9- 83,3). Inversamente, en 49 sospechas descartadas se dispuso de muestras de exudado faríngeo para RT-PCR como de sangre para serología y en 49 la RT-PCR resultó negativa (especificidad 100%, IC95% 90,9- 99,8). En 1 muestra de una sospecha descartada la IgM fue positiva (especificidad 98,0%, IC95% 87,8- 99,9).
En la etapa de eliminación del sarampión y la rubéola los estándares de vigilancia deben ir dirigidos a detectar todos los posibles casos. Para ello es preciso la obtención en tiempos correctos de las muestras biológicas adecuadas (suero y especialmente exudado faríngeo).
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Affiliation(s)
- Juan Carlos Sanz
- Unidad de Microbiología Clínica. Laboratorio Regional de Salud Pública de la Comunidad. Dirección General de Salud Pública. Consejería de Sanidad. Comunidad de Madrid. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
| | - Isabel Vadillo
- Unidad de Microbiología Clínica. Laboratorio Regional de Salud Pública de la Comunidad. Dirección General de Salud Pública. Consejería de Sanidad. Comunidad de Madrid
| | - Teresa Gómez
- Unidad de Microbiología Clínica. Laboratorio Regional de Salud Pública de la Comunidad. Dirección General de Salud Pública. Consejería de Sanidad. Comunidad de Madrid
| | - Juan Emilio Echevarría
- Laboratorio Nacional de Referencia de Sarampión y Rubéola. Centro Nacional de Microbiología (CNM). Instituto de Salud Carlos III (ISCIII). Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
| | - Aurora Fernández
- Laboratorio Nacional de Referencia de Sarampión y Rubéola. Centro Nacional de Microbiología (CNM). Instituto de Salud Carlos III (ISCIII). Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
| | - Fernando de Ory
- Laboratorio Nacional de Referencia de Sarampión y Rubéola. Centro Nacional de Microbiología (CNM). Instituto de Salud Carlos III (ISCIII). Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
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Moss W. Measles in Vaccinated Individuals and the Future of Measles Elimination. Clin Infect Dis 2019; 67:1320-1321. [PMID: 29878095 DOI: 10.1093/cid/ciy306] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/09/2018] [Indexed: 01/23/2023] Open
Affiliation(s)
- William Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Ma R, Lu L, Suo L, Zhangzhu J, Chen M, Pang X. Evaluation of the adequacy of measles laboratory diagnostic tests in the era of accelerating measles elimination in Beijing, China. Vaccine 2019; 37:3804-3809. [DOI: 10.1016/j.vaccine.2019.05.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 05/10/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
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Simultaneous Detection and Differentiation between Wild-Type and Vaccine Measles Viruses by a Multiplex Real-Time Reverse Transcription-PCR Assay. J Clin Microbiol 2019; 57:JCM.01828-18. [PMID: 30760529 DOI: 10.1128/jcm.01828-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/04/2019] [Indexed: 11/20/2022] Open
Abstract
Measles is one of the most contagious viral respiratory infections and was declared to be eliminated from Canada in 1998; however, measles cases and outbreaks still occur every year through reintroduction from other parts of the world. Laboratory confirmation of measles virus (MV) RNA by real-time PCR provides a definitive diagnosis, and molecular analysis to determine the genotype is the only way to distinguish between wild-type and vaccine strains. This distinction is important since live attenuated vaccine strains are able to replicate in the patient and can be associated with rash and fever but are poorly transmissible, if at all. Prompt reporting of measles cases to local authorities, including differentiation between wild-type and vaccine strains, allows for optimal management and contact tracing. The development and validation of a multiplex real-time reverse transcription-PCR (rtRT-PCR) assay for the simultaneous detection and differentiation of the Moraten and Schwarz vaccine strains from presumptive wild-type MV in a format that can be easily implemented for high-throughput testing of patient samples are reported here. This assay is sensitive, specific, reproducible, and 100% accurate in comparison with the gold standard comparator assay.
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Haralambieva IH, Kennedy RB, Ovsyannikova IG, Schaid DJ, Poland GA. Current perspectives in assessing humoral immunity after measles vaccination. Expert Rev Vaccines 2018; 18:75-87. [PMID: 30585753 DOI: 10.1080/14760584.2019.1559063] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Repeated measles outbreaks in countries with relatively high vaccine coverage are mainly due to failure to vaccinate and importation; however, cases in immunized individuals exist raising questions about suboptimal measles vaccine-induced humoral immunity and/or waning immunity in a low measles-exposure environment. AREAS COVERED The plaque reduction neutralization measurement of functional measles-specific antibodies correlates with protection is the gold standard in measles serology, but it does not assess cellular-immune or other parameters that may be associated with durable and/or protective immunity after vaccination. Additional correlates of protection and long-term immunity and new determinants/signatures of vaccine responsiveness such as specific CD46 and IFI44L genetic variants associated with neutralizing antibody titers after measles vaccination are under investigation. Current and future systems biology studies, coupled with new technology/assays and analytical approaches, will lead to an increasingly sophisticated understanding of measles vaccine-induced humoral immunity and will identify 'signatures' of protective and durable immune responses. EXPERT OPINION This will translate into the development of highly predictive assays of measles vaccine efficacy, effectiveness, and durability for prospective identification of potential low/non-responders and susceptible individuals who require additional vaccine doses. Such new advances may drive insights into the development of new/improved vaccine formulations and delivery systems.
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Affiliation(s)
| | - Richard B Kennedy
- a Mayo Clinic Vaccine Research Group , Mayo Clinic , Rochester , MN , USA
| | | | - Daniel J Schaid
- a Mayo Clinic Vaccine Research Group , Mayo Clinic , Rochester , MN , USA.,b Department of Health Sciences Research , Mayo Clinic , Rochester , MN , USA
| | - Gregory A Poland
- a Mayo Clinic Vaccine Research Group , Mayo Clinic , Rochester , MN , USA
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Importance of real-time RT-PCR to supplement the laboratory diagnosis in the measles elimination program in China. PLoS One 2018; 13:e0208161. [PMID: 30500842 PMCID: PMC6267958 DOI: 10.1371/journal.pone.0208161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/13/2018] [Indexed: 11/19/2022] Open
Abstract
In addition to high vaccination coverage, timely and accurate laboratory confirmation of measles cases is critical to interrupt measles transmission. To evaluate the role of real-time reverse transcription-polymerase chain reaction (RT-PCR) in the diagnosis of measles cases, 46,363 suspected measles cases with rash and 395 suspected measles cases without rash were analyzed in this study; the cases were obtained from the Chinese measles surveillance system (MSS) during 2014–2017 and simultaneously detected by measles-specific IgM enzyme-linked immunosorbent assay (ELISA) and real-time RT-PCR. However, some IgM-negative measles cases were identified by real-time RT-PCR. The proportion of these IgM-negative and viral nucleic acid-positive measles cases was high among measles cases with measles vaccination history, cases without rash symptoms, and cases within 3 days of specimen collection after onset. The proportion of IgM-negative and viral nucleic acid-positive measles cases in the 0–3 day group was up to 14.4% for measles cases with rash and 40% for measles cases without rash. Moreover, the proportions of IgM-negative and nucleic acid-positive measles cases gradually increased with the increase in the measles vaccination dose. Therefore, integrated with IgM ELISA, real-time RT-PCR would greatly improve the accurate diagnosis of measles cases and avoid missing the measles cases, especially for measles cases during the first few days after onset when the patients were highly contagious and for measles cases with secondary vaccine failure. In conclusion, our study reconfirmed that IgM ELISA is the gold-standard detection assay for measles cases confirmation. However, real-time RT-PCR should be introduced and used to supplement the laboratory diagnosis, especially in the setting of pre-elimination and/or elimination wherever appropriate.
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Ng AHC, Fobel R, Fobel C, Lamanna J, Rackus DG, Summers A, Dixon C, Dryden MDM, Lam C, Ho M, Mufti NS, Lee V, Asri MAM, Sykes EA, Chamberlain MD, Joseph R, Ope M, Scobie HM, Knipes A, Rota PA, Marano N, Chege PM, Njuguna M, Nzunza R, Kisangau N, Kiogora J, Karuingi M, Burton JW, Borus P, Lam E, Wheeler AR. A digital microfluidic system for serological immunoassays in remote settings. Sci Transl Med 2018; 10:10/438/eaar6076. [DOI: 10.1126/scitranslmed.aar6076] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/06/2018] [Indexed: 12/29/2022]
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Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction. Epidemiol Infect 2018. [PMID: 29532766 PMCID: PMC9134572 DOI: 10.1017/s0950268818000407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
This study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture–recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75–87). Completeness was >98% for mandatory variables and 57% for ‘genotyping’. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.
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