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Wang H, Zhu Z, Duan X, Song J, Mao N, Cui A, Wang C, Du H, Wang Y, Li F, Zhou S, Feng D, Li C, Gao H, He J, Li L, Lei Y, Zheng H, Gong T, Hu Y, Xu C, Zhao H, Sun Z, Chen Y, Tang X, Chen M, Deng L, Wang S, Tian X, Zhang T, Si Y, Yuan F, Fan L, Mahemutijiang K, Chen Z, Chen H, Xu W, Zhang Y. Transmission Pattern of Measles Virus Circulating in China During 1993-2021: Genotyping Evidence Supports That China Is Approaching Measles Elimination. Clin Infect Dis 2023; 76:e1140-e1149. [PMID: 36037029 DOI: 10.1093/cid/ciac674] [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: 04/06/2022] [Revised: 08/04/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To provide useful insights into measles elimination progress in China, measles surveillance data were reviewed, and the transmission patterns of measles viruses circulating in China during 1993-2021 were analyzed. METHODS Measles incidence data from the National Notifiable Disease Reporting System of the China Center for Disease Control and Prevention were analyzed. A total of 17 570 strains were obtained from 30 of 31 provinces in mainland China during 1993-2021. The recommended genotyping window was amplified. Genotyping analysis was conducted for comparison with the reference strains. Phylogenetic analyses were performed to identify genetic relationships among different lineages within the genotypes. RESULTS With high coverage of routine immunization and intensive supplementary immunization activities, measles incidence has shown a downward trend since 1993, despite 2 resurgences, reaching a historic low level in 2020-2021 (average 0.5 per million). During 1993-2021, 9 genotypes including domestic genotype H1; imported genotypes B3, D4, D8, D9, D11, G3, and H2; and vaccine-associated genotype A were identified. Among them, the genotype H1 strain circulated endemically in China for more than 25 years; the last strain was detected in Yunnan Province in September 2019. Multiple imported genotypes have been identified since 2009 showing different transmission patterns. Since April 2020, no imported strains have been detected, while vaccine-associated genotype A continues to be detected. CONCLUSIONS The evidence of low incidence during 2020-2021 and virological surveillance data in this study confirm that China is currently approaching measles elimination.
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Affiliation(s)
- Huiling Wang
- World Health Organization Western Pacific Regional Office Regional Reference Laboratory of Measles and Rubella, National Health Commission Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhen Zhu
- World Health Organization Western Pacific Regional Office Regional Reference Laboratory of Measles and Rubella, National Health Commission Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaojian Duan
- World Health Organization Western Pacific Regional Office Regional Reference Laboratory of Measles and Rubella, National Health Commission Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinhua Song
- World Health Organization Western Pacific Regional Office Regional Reference Laboratory of Measles and Rubella, National Health Commission Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Naiying Mao
- World Health Organization Western Pacific Regional Office Regional Reference Laboratory of Measles and Rubella, National Health Commission Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Aili Cui
- World Health Organization Western Pacific Regional Office Regional Reference Laboratory of Measles and Rubella, National Health Commission Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Changyin Wang
- Provincial Measles/Rubella Laboratory, Shandong Provincial Center for Disease Control and Prevention, Jinan, China
| | - Hui Du
- Provincial Measles/Rubella Laboratory, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China
| | - Yan Wang
- Provincial Measles/Rubella Laboratory, Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Fangcai Li
- Provincial Measles/Rubella Laboratory, Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Shujie Zhou
- Provincial Measles/Rubella Laboratory, Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Daxing Feng
- Provincial Measles/Rubella Laboratory, Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Chongshan Li
- Provincial Measles/Rubella Laboratory, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Hui Gao
- Provincial Measles/Rubella Laboratory, Shanxi Provincial Center for Disease Control and Prevention, Taiyuan, China
| | - Jilan He
- Provincial Measles/Rubella Laboratory, Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Liqun Li
- Provincial Measles/Rubella Laboratory, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Yue Lei
- Provincial Measles/Rubella Laboratory, Tianjin Municipal Center for Disease Control and Prevention, Tianjin, China
| | - Huanying Zheng
- Provincial Measles/Rubella Laboratory, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Tian Gong
- Provincial Measles/Rubella Laboratory, Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, China
| | - Ying Hu
- Provincial Measles/Rubella Laboratory, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Changping Xu
- Provincial Measles/Rubella Laboratory, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Hua Zhao
- Provincial Measles/Rubella Laboratory, Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Zhaodan Sun
- Provincial Measles/Rubella Laboratory, Heilongjiang Provincial Center for Disease Control and Prevention, Ha'erbin, China
| | - Ying Chen
- Provincial Measles/Rubella Laboratory, Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Xiaomin Tang
- Provincial Measles/Rubella Laboratory, Guizhou Provincial Center for Disease Control and Prevention, Guiyang, China
| | - Meng Chen
- Provincial Measles/Rubella Laboratory, Beijing Municipal Center for Disease Control and Prevention, Beijing, China
| | - Lili Deng
- Provincial Measles/Rubella Laboratory, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Shuang Wang
- Provincial Measles/Rubella Laboratory, Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Xiaoling Tian
- Provincial Measles/Rubella Laboratory, Neimenggu Center for Disease Control and Prevention, Huhehaote, China
| | - Ting Zhang
- Provincial Measles/Rubella Laboratory, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Yuan Si
- Provincial Measles/Rubella Laboratory, Shaanxi Provincial Center for Disease Control and Prevention, Xian, China
| | - Fang Yuan
- Provincial Measles/Rubella Laboratory, Ningxia Center for Disease Control and Prevention, Yinchuan, China
| | - Lixia Fan
- Provincial Measles/Rubella Laboratory, Qinghai Provincial Center for Disease Control and Prevention, Xining, China
| | - Kuerban Mahemutijiang
- Provincial Measles/Rubella Laboratory, Xinjiang Center for Disease Control and Prevention, Wulumuqi, China
| | - Zhifei Chen
- Provincial Measles/Rubella Laboratory, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Haiyun Chen
- Provincial Measles/Rubella Laboratory, Hainan Provincial Center for Disease Control and Prevention, Haikou, China
| | - Wenbo Xu
- World Health Organization Western Pacific Regional Office Regional Reference Laboratory of Measles and Rubella, National Health Commission Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Zhang
- World Health Organization Western Pacific Regional Office Regional Reference Laboratory of Measles and Rubella, National Health Commission Key Laboratory of Medical Virology and Viral Diseases, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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2
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Yuan C, Wang C, Zhu K, Li S, Miao Z. Measles Epidemiology and Viral Nucleoprotein Gene Evolution in Shandong Province, China. J Med Virol 2022; 94:4926-4933. [PMID: 35711081 DOI: 10.1002/jmv.27941] [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: 01/19/2022] [Revised: 05/18/2022] [Accepted: 06/14/2022] [Indexed: 11/07/2022]
Abstract
Measles, caused by measles virus (MeV), has not been eradicated in many regions and countries, threatening human health. Thus, it is beneficial for measles elimination to understand measles epidemiology and molecular evolution of key viral genes, such as nucleoprotein (N) gene. Based on public data, measles epidemiological information and MeV N gene sequences reported in Shandong Province, China were comprehensively collected and systematically analyzed. The results showed a positive correlation between population density and measles incidence (r = + 0.31), while negative correlations were found between measles incidence and healthcare condition (r = - 0.21) as well as average routine vaccination rate (r = - 0.11). Additionally, the predominant lineage of MeV in Shandong was formed by genotype H1 strains, and the time of the most recent common ancestor of the N gene of MeV genotype H1 in Shandong traced back to 1987 (95% highest posterior density, 1984-1990) with relatively rapid evolution (mean rate, 1.267×10-3 substitutions/site/year). The genetic diversity of MeV N gene increased with the substantial emergence of major divergent clades of genotype H1 before 2005 and then remained relatively stable. In summary, these findings provided a significant insight into the measles elimination. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chuang Yuan
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230026, China.,School of Life Sciences, Shandong First Medical University, Tai'an, Shandong, 271000, China
| | - Cheng Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Shandong, 250002, China.,National Institute of Health Data Science of China, Shandong University, Shandong, 250002, China
| | - Kongfu Zhu
- School of Life Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, 230026, China
| | - Song Li
- School of Basic Medicine, Shandong First Medical University, Tai'an, Shandong, 271000, China
| | - Zengmin Miao
- School of Life Sciences, Shandong First Medical University, Tai'an, Shandong, 271000, China
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3
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Song J, Li C, Rivailler P, Wang H, Hu M, Zhu Z, Cui A, Mao N, Xu W, Zhang Y. Molecular evolution and genomic characteristics of genotype H1 of measles virus. J Med Virol 2021; 94:521-530. [PMID: 34761827 DOI: 10.1002/jmv.27448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022]
Abstract
Measles is one of the most infectious diseases of humans. It is caused by the measles virus (MeV) and can lead to serious illness, lifelong complications, and even death. Whole-genome sequencing (WGS) is now available to study molecular epidemiology and identify MeV transmission pathways. In the present study, WGS of 23 MeV strains of genotype H1, collected in Mainland China between 2006 and 2018, were generated and compared to 31 WGSs from the public domain to analyze genomic characteristics, evolutionary rates and date of emergence of H1 genotype. The noncoding region between M and F protein genes (M/F NCR) was the most variable region throughout the genome. Although the nucleotide substitution rate of H1 WGS was around 0.75 × 10-3 substitution per site per year, the M/F NCR had an evolutionary rate three times higher, with 2.44 × 10-3 substitution per site per year. Phylogenetic analysis identified three distinct genetic groups. The Time of the Most Recent Common Ancestor (TMRCA) of H1 genotype was estimated at approximately 1988, while the first genetic group appeared around 1995 followed by two other genetic groups in 1999-2002. Bayesian skyline plot showed that the genetic diversity of the H1 genotype remained stable even though the number of MeV cases decreased 50 times between 2014 (52 628) and 2020 (993). The current coronavirus disease 2019 (COVID-19) pandemic might have some effect on the measles epidemic and further studies will be necessary to assess the genetic diversity of the H1 genotype in a post-COVID area.
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Affiliation(s)
- Jinhua Song
- National Health Commission (NHC) Key Laboratory of Medical Virology and Viral Diseases. National Institute for Viral Disease Control and Prevention, China CDC;, WHO WPRO Regional Reference Measles/Rubella Laboratory, Beijing, China
| | - Chongshan Li
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai
| | - Pierre Rivailler
- National Health Commission (NHC) Key Laboratory of Medical Virology and Viral Diseases. National Institute for Viral Disease Control and Prevention, China CDC;, WHO WPRO Regional Reference Measles/Rubella Laboratory, Beijing, China
| | - Huiling Wang
- National Health Commission (NHC) Key Laboratory of Medical Virology and Viral Diseases. National Institute for Viral Disease Control and Prevention, China CDC;, WHO WPRO Regional Reference Measles/Rubella Laboratory, Beijing, China
| | - Manli Hu
- National Health Commission (NHC) Key Laboratory of Medical Virology and Viral Diseases. National Institute for Viral Disease Control and Prevention, China CDC;, WHO WPRO Regional Reference Measles/Rubella Laboratory, Beijing, China.,Department of Public Health Laboratory Sciences, School of Public Health, Changsha Medical University, Changsha, Hunan, China
| | - Zhen Zhu
- National Health Commission (NHC) Key Laboratory of Medical Virology and Viral Diseases. National Institute for Viral Disease Control and Prevention, China CDC;, WHO WPRO Regional Reference Measles/Rubella Laboratory, Beijing, China
| | - Aili Cui
- National Health Commission (NHC) Key Laboratory of Medical Virology and Viral Diseases. National Institute for Viral Disease Control and Prevention, China CDC;, WHO WPRO Regional Reference Measles/Rubella Laboratory, Beijing, China
| | - Naiying Mao
- National Health Commission (NHC) Key Laboratory of Medical Virology and Viral Diseases. National Institute for Viral Disease Control and Prevention, China CDC;, WHO WPRO Regional Reference Measles/Rubella Laboratory, Beijing, China
| | - Wenbo Xu
- National Health Commission (NHC) Key Laboratory of Medical Virology and Viral Diseases. National Institute for Viral Disease Control and Prevention, China CDC;, WHO WPRO Regional Reference Measles/Rubella Laboratory, Beijing, China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Beijing, China
| | - Yan Zhang
- National Health Commission (NHC) Key Laboratory of Medical Virology and Viral Diseases. National Institute for Viral Disease Control and Prevention, China CDC;, WHO WPRO Regional Reference Measles/Rubella Laboratory, Beijing, China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Beijing, China
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Measles Vaccine-Associated Rash Illness in China: an Emerging Issue in the Process of Measles Elimination. J Clin Microbiol 2020; 58:JCM.01472-20. [PMID: 32878947 DOI: 10.1128/jcm.01472-20] [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: 06/12/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022] Open
Abstract
Along with the implementation of measles case-based surveillance, measles vaccine-associated rash illness (VARI) cases were detected in China. To better understand the characteristics of VARI, 101 VARI cases confirmed by measles virus genotyping in 2011 to 2018 were analyzed in this study. With the decrease in measles incidence, the detection rate of VARI cases increased among the cases confirmed by genotyping. Compared with genotype H1 wild-type measles, VARI occurred throughout the year, without obvious seasonal distribution. Infants and children of ages 8 to 23 months were the main population of VARI. VARI mainly occurred within 14 days after measles vaccination. The number of VARI cases peaked on the 8th day after measles vaccination, which was later than that of genotype H1 wild-type measles cases with a measles vaccination history. VARI presents clinical symptoms similar to those of measles. The frequencies of the "3Cs" (cough, coryza, and conjunctivitis), Koplik spots, and complications in VARI cases were significantly lower than those in wild-type measles cases. In total, 94.06% of sequences from VARI cases were identical to measles vaccine strain S191 in the C-terminal 450-nucleotide sequence of the nucleoprotein (N-450) gene. A few substitutions were found in N-450 sequences of the VARI cases. The confirmation of VARI has become an emerging issue in the process of measles elimination. Rapid confirmation of VARI is critical for measles surveillance and will help to determine the response measures for measles, especially in measles preelimination and elimination settings. The suspected measles cases with measles-containing vaccine (MCV) vaccination were recommended to be tested by the laboratory to identify wild-type measles or VARI.
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Measles outbreak in an office building in the crowded Metropolis of Beijing, China. BMC Infect Dis 2019; 19:771. [PMID: 31481053 PMCID: PMC6724294 DOI: 10.1186/s12879-019-4404-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 08/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Although worldwide measles elimination achieved great progress for decades, outbreaks were still reported in certain countries. This study describes the epidemiologic features of a substantial measles outbreak in an office building in Beijing and explores control strategies in a crowded city. Methods We performed descriptive analyses of data on demographic characteristic, laboratory testing and epidemiological information. Results From February 25 to March 28, 2016, 43 outbreak-related measles cases occurred in an office building in Beijing. The total crude attack rate was 1.20% in the building. The age range of patients was 23 to 45 years old, of whom 30 (69.8%) were migrants and 5 (11.6%) were vaccinated but without documentation. The attack rate of the department and the company of the source case was 22.73 and 11.86%, respectively. The attack rate in the building was 1.78%, except for the commercial center on the lower floors, which was 0.34%. Of the 43 measles cases, only 19 cases (53.5%) were reported by hospitals through the National Notifiable Disease Reporting System (NNDRS), and the rest were found through active surveillance. Outbreak response immunization was conducted for 6216 persons. Conclusions Office buildings in crowded metropolis are prone to large-scale measles outbreaks, and require a rapid outbreak response. Early Outbreak response immunization and active surveillance are important strategies to control outbreaks such as the one reported herein.
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Molecular characterization of measles viruses in China: Circulation dynamics of the endemic H1 genotype from 2011 to 2017. PLoS One 2019; 14:e0218782. [PMID: 31220172 PMCID: PMC6586441 DOI: 10.1371/journal.pone.0218782] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 06/11/2019] [Indexed: 11/19/2022] Open
Abstract
Due to the Expanded Program on Immunization (EPI) and supplementary immunization activities (SIAs) in China, the incidence of measles in China has decreased extensively. The incidence reached its lowest levels in contemporary history in 2012 and 2017, with incidence rates of 4.6 and 4.3 per million population, respectively. However, more than 147,000 measles cases were reported from 2013 to 2016. Furthermore, the proportions of cases in infants < 8 months and adults have been increasing since 2013, representing a considerable challenge for measles elimination in China. A total of 14,868 measles viruses were isolated from confirmed measles cases from 2011 to 2017, of which 14,631 were identified as the predominant endemic genotype, H1; 87 were identified as genotype A viruses that were vaccine associated strains; and 150 were identified as non-H1 genotype viruses. The non-H1 genotype viruses included 62 D8 viruses, 70 D9 viruses, 3 D11 viruses, 14 B3 viruses, and 1 G3 virus, which were identified as imported or import-related viruses that caused sporadic cases or small outbreaks. Most of the transmission chains detected during the period 2011–2012 were interrupted and were followed by many new transmission chains of unknown origin that spread, causing a large measles resurgence in China during 2013–2016. After 4 years of measles resurgence and continuous implementation of the routine immunization program and SIAs, the population immunity reached a sufficiently high level to interrupt most of the transmission chains; only a few strains survived, which continued to be sporadically detected in China in 2017. In the present study, the results from the combined epidemiological and molecular virological data demonstrated the great progress towards measles elimination in China by the further analysis of circulation dynamics for the endemic H1 genotype measles virus from 2011 to 2017. And this study accumulated critical baseline data on circulating wild-type measles viruses in China and provides comprehensive information to the world. These comprehensive baseline data provide evidence to support measles elimination in the future, not only in China but also in other countries worldwide. In addition, the information will be very useful to other countries for tracing their sources of measles cases and for identifying transmission links, which can help prevent potential measles outbreaks.
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Deng X, Hu Y, Lu P, Zhou MH, Guo H. The first outbreak of measles virus caused by imported genotype D8 in Jiangsu province of China. Braz J Infect Dis 2019; 23:66-69. [PMID: 30876879 PMCID: PMC9428010 DOI: 10.1016/j.bjid.2019.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022] Open
Abstract
Here we reported the outbreak of measles cases caused by the genotype D8 measles virus for the first time in Jiangsu province in China, which was possibly imported by a foreign student from Laos. Throat swab specimens were collected, and used to isolate virus. 634-bp fragment of the N gene and 1854-bp fragment of H gene were amplified by reverse transcription-PCR and sequenced, respectively. Phylogenetic results indicated that they belonged to genotype D8 measles virus. Further epidemiology investigation showed that the adults with D8 measles virus infection did not receive measles vaccine before having measles. In China, almost all D8 genotype MeV only infected those population without receiving measles vaccine immunization. Therefore, it is still necessary to implement the supplement activity of measles immunization target adult with immunity gap.
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Affiliation(s)
- Xiuying Deng
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ying Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Peishan Lu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Ming-Hao Zhou
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hongxiong Guo
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China.
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8
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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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Xu W, Zhang Y, Wang H, Zhu Z, Mao N, Mulders MN, Rota PA. Global and national laboratory networks support high quality surveillance for measles and rubella. Int Health 2017; 9:184-189. [PMID: 28582561 DOI: 10.1093/inthealth/ihx017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/08/2017] [Indexed: 11/12/2022] Open
Abstract
Laboratory networks are an essential component of disease surveillance systems because they provide accurate and timely confirmation of infection. WHO coordinates global laboratory surveillance of vaccine preventable diseases, including measles and rubella. The more than 700 laboratories within the WHO Global Measles and Rubella Laboratory Network (GMRLN) supports surveillance for measles, rubella and congenial rubella syndrome in 191 counties. This paper describes the overall structure and function of the GMRLN and highlights the largest of the national laboratory networks, the China Measles and Rubella Laboratory Network.
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Affiliation(s)
- Wenbo Xu
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yan Zhang
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huiling Wang
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhen Zhu
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Naiying Mao
- WHO WPRO Regional Reference Measles/Rubella Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Mick N Mulders
- Expanded Program on Immunization, World Health Organization, Geneva, Switzerland
| | - Paul A Rota
- Division of Viral Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
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10
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Zahoor MA. Global eradication of measles virus: current status. Future Virol 2017. [DOI: 10.2217/fvl-2017-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Perspective on Global Measles Epidemiology and Control and the Role of Novel Vaccination Strategies. Viruses 2017; 9:v9010011. [PMID: 28106841 PMCID: PMC5294980 DOI: 10.3390/v9010011] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/21/2022] Open
Abstract
Measles is a highly contagious, vaccine preventable disease. Measles results in a systemic illness which causes profound immunosuppression often leading to severe complications. In 2010, the World Health Assembly declared that measles can and should be eradicated. Measles has been eliminated in the Region of the Americas, and the remaining five regions of the World Health Organization (WHO) have adopted measles elimination goals. Significant progress has been made through increased global coverage of first and second doses of measles-containing vaccine, leading to a decrease in global incidence of measles, and through improved case based surveillance supported by the WHO Global Measles and Rubella Laboratory Network. Improved vaccine delivery methods will likely play an important role in achieving measles elimination goals as these delivery methods circumvent many of the logistic issues associated with subcutaneous injection. This review highlights the status of global measles epidemiology, novel measles vaccination strategies, and describes the pathway toward measles elimination.
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Cui A, Zhu Z, Hu Y, Deng X, Sun Z, Zhang Y, Mao N, Xu S, Fang X, Gao H, Si Y, Lei Y, Zheng H, He J, Wu H, Xu W. Mumps Epidemiology and Mumps Virus Genotypes Circulating in Mainland China during 2013-2015. PLoS One 2017; 12:e0169561. [PMID: 28085897 PMCID: PMC5234798 DOI: 10.1371/journal.pone.0169561] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022] Open
Abstract
With the implementation of mumps virus (MuV) vaccination in the expanded program on immunization (EPI) in mainland China since 2008, the incidence of mumps has decreased, and the natural epidemic pattern of mumps has slightly changed during 2013-2015. The two epidemic peaks (April-July and November-December) became less obvious than those observed from 2004 to 2012. Children and adolescents younger than 15, particularly in the five-to-nine-year-old age group, remain the target group and should be the focus of high-quality immunization activities in mainland China. However, it was also found that the incidence and reported cases of mumps decreased in each age group during 2013-2015, particularly in the five-to-nine-year-old and ten-to-fourteen-year-old age groups. The proportion of mumps cases among adults in some provinces also increased. Unlike the changes in the epidemiological characteristics of mumps affected by vaccination, the data of MuV virology surveillance indicated that most of the MuV transmission chains have not yet been effectively interrupted, and MuV remains a natural epidemic pattern in mainland China. In the MuV virology surveillance, 194 MuV strains during 2013-2015 were isolated from 10 of 31 provinces in mainland China. Based on the phylogenetic analysis of the small hydrophobic (SH) gene, both genotype F (99.0%) and G (1.0%) were identified, and genotype F was still the predominant genotype continuously circulating in mainland China. Representative genotype F and G strains isolated in China from 1995 to 2012 were selected for further analysis. The results indicated that there were multiple transmission chains within genotype F, with no obvious geographical or time differences. The high genetic diversity of genotype F strains could be a result of the continuous transmission and evolution of the MuV in mainland China. Genotype G was also detected in four provinces in mainland China. Because of the limited epidemiological data, it was uncertain whether the genotype G MuV strains found in 2011 and 2013 were imported from other countries. Therefore, combined high-quality epidemiological and virological surveillance is necessary for mumps control; it can also be used to observe the changes in epidemiological characteristics and viral transmission of mumps over time after mumps-containing vaccine (MuCV) implementation and to provide a comprehensive epidemiological and genetic baseline for mumps elimination in mainland China.
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Affiliation(s)
- Aili Cui
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zhen Zhu
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Ying Hu
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, People’s Republic of China
| | - Xiuying Deng
- Jiangsu Provincial Centers for Disease Control and Prevention, Nanjing, People’s Republic of China
| | - Zhaodan Sun
- Heilongjiang Provincial Centers for Disease Control and Prevention, Ha’erbin, People’s Republic of China
| | - Yan Zhang
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Naiying Mao
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Songtao Xu
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
| | - Xueqiang Fang
- Shandong Provincial Centers for Disease Control and Prevention, Jinan, People’s Republic of China
| | - Hui Gao
- Shanxi Provincial Centers for Disease Control and Prevention, Taiyuan, People’s Republic of China
| | - Yuan Si
- Shannxi Provincial Centers for Disease Control and Prevention, Xi’an, People’s Republic of China
| | - Yake Lei
- Hubei Provincial Centers for Disease Control and Prevention, Wuhan, People’s Republic of China
| | - Huanying Zheng
- Guangdong Provincial Centers for Disease Control and Prevention, Guangzhou, People’s Republic of China
| | - Jilan He
- Sichuan Provincial Centers for Disease Control and Prevention, Chengdu, People’s Republic of China
| | - Hongwei Wu
- Affiliated hospital of Beihua University, Jilin, People’s Republic of China
- * E-mail: (WX); (HW)
| | - Wenbo Xu
- WHO WPRO Regional Reference Measles/Rubella Laboratory and Key Laboratory of Medical Virology Ministry of Health, National Institute for Viral Disease Control and Prevention, Beijing, People’s Republic of China
- * E-mail: (WX); (HW)
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Zeng SZ, Zhang B, Zhang Y, Xie LY, Xiong J, Yu T, Xie ZP, Gao HC, Duan ZJ. Identification of 12 Cases of Acute Measles Encephalitis Without Rash: Table 1. Clin Infect Dis 2016; 63:1630-1633. [DOI: 10.1093/cid/ciw611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/29/2016] [Indexed: 11/13/2022] Open
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Abstract
Measles is an infectious disease in humans caused by the measles virus (MeV). Before the introduction of an effective measles vaccine, virtually everyone experienced measles during childhood. Symptoms of measles include fever and maculopapular skin rash accompanied by cough, coryza and/or conjunctivitis. MeV causes immunosuppression, and severe sequelae of measles include pneumonia, gastroenteritis, blindness, measles inclusion body encephalitis and subacute sclerosing panencephalitis. Case confirmation depends on clinical presentation and results of laboratory tests, including the detection of anti-MeV IgM antibodies and/or viral RNA. All current measles vaccines contain a live attenuated strain of MeV, and great progress has been made to increase global vaccination coverage to drive down the incidence of measles. However, endemic transmission continues in many parts of the world. Measles remains a considerable cause of childhood mortality worldwide, with estimates that >100,000 fatal cases occur each year. Case fatality ratio estimates vary from <0.01% in industrialized countries to >5% in developing countries. All six WHO regions have set goals to eliminate endemic transmission of MeV by achieving and maintaining high levels of vaccination coverage accompanied by a sensitive surveillance system. Because of the availability of a highly effective and relatively inexpensive vaccine, the monotypic nature of the virus and the lack of an animal reservoir, measles is considered a candidate for eradication.
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15
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A 16-year review of seroprevalence studies on measles and rubella. Vaccine 2016; 34:4110-4118. [PMID: 27340097 DOI: 10.1016/j.vaccine.2016.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 05/15/2016] [Accepted: 06/01/2016] [Indexed: 01/31/2023]
Abstract
The determination of the seroprevalence of vaccine-preventable diseases is critical in monitoring the efficacy of vaccination programmes and to assess the gaps in population immunity but requires extensive organisation and is time and resource intensive. The results of the studies are frequently reported in peer-reviewed scientific, government and non-government publications. A review of scientific literature was undertaken to advise the development of WHO guidelines for the assessment of measles and rubella seroprevalence. A search of the National Library of Medicine's PubMed online publications using key words of 'measles', 'rubella', combined with 'serosurvey', 'seroprevalence', 'immunity' and 'population immunity' was conducted. A total of 97 articles published between January 1998 and June 2014 were retrieved, 68 describing serosurveys for measles and 58 serosurveys for rubella, conducted in 37 and 36 different countries respectively. Only 13 (19%) and 8 (14%) respectively were UN classified "least developed countries". The study sample varied markedly and included combinations of male and female infants, children, adolescents and adults. The study sizes also varied with 28% and 33% of measles and rubella studies respectively, having greater than 2000 participants. Microtitre plate enzyme immunoassays were used in 52 (76%) measles studies and 40 (69%) rubella studies. A total of 39 (57%) measles and 44 (76%) rubella studies reported quantitative test results. Seroprevalence ranged from 60.8% to 95.9% for measles and 53.0% to 99.3% for rubella studies. The review highlighted that infants lost maternally-acquired immunity within 9months of birth and were unprotected until vaccination. Two groups at higher risk of infection were identified: young adults between the ages of 15 and 30years and immigrants.
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Xu W, Zhang MX, Qin EQ, Yan YC, Li FY, Xu Z, Tian X, Fan R, Tu B, Chen WW, Zhao M. Molecular Characterization of Wild Type Measles Virus from Adult Patients in Northern China, 2014. Int J Infect Dis 2016; 45:36-42. [PMID: 26899955 DOI: 10.1016/j.ijid.2016.02.008] [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: 09/25/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES In this study, we studied the N and H genes from wild type measles viruses (MeVs) isolated during the 2013-2014 outbreak. METHODS Clinical samples were collected, and the genotyping, phylogenetic analysis were performed. RESULTS The vaccination rate of the study population was 4%. Genotype H1a was the predominant genotype. Wild type viruses were classified into clusters A and B, C and may have different origins. N-450 sequences from wild type viruses were highly homologous with, and likely evolved from MeVs circulating in Tianjing and Henan in 2012. MVs/Shenyang.CHN/18.14/3 could have evolved from MeVs from Liaoning, Beijing, Hebei, Heilongjiang, Henan, Jilin, and Tianjin. Our data suggested that one or more of the same viruses circulated between Beijing, Shenyang, Hong Kong, Taiwan and Berlin. CONCLUSIONS Important factors contributing to outbreaks could include weak vaccination coverage, poor vaccination strategies, and migration of adult workers between cities, countries, and from rural areas to urban areas.
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Affiliation(s)
- Wen Xu
- Treatment and Research Center for Infectious Diseases, 302 Military Hospital of China, 100039 Beijing, China
| | - Ming-Xiang Zhang
- Department of Infectious Diseases, The Sixth People's Hospital of Shenyang, 110006 Shenyang, China
| | - En-Qiang Qin
- Treatment and Research Center for Infectious Diseases, 302 Military Hospital of China, 100039 Beijing, China
| | - Ying-Chun Yan
- Department of Infectious Diseases, The Sixth People's Hospital of Shenyang, 110006 Shenyang, China
| | - Feng-Yi Li
- Treatment and Research Center for Infectious Diseases, 302 Military Hospital of China, 100039 Beijing, China
| | - Zhe Xu
- Treatment and Research Center for Infectious Diseases, 302 Military Hospital of China, 100039 Beijing, China
| | - Xia Tian
- Department of Infectious Diseases, The Sixth People's Hospital of Shenyang, 110006 Shenyang, China
| | - Rong Fan
- Treatment and Research Center for Infectious Diseases, 302 Military Hospital of China, 100039 Beijing, China
| | - Bo Tu
- Treatment and Research Center for Infectious Diseases, 302 Military Hospital of China, 100039 Beijing, China
| | - Wei-Wei Chen
- Treatment and Research Center for Infectious Diseases, 302 Military Hospital of China, 100039 Beijing, China.
| | - Min Zhao
- Treatment and Research Center for Infectious Diseases, 302 Military Hospital of China, 100039 Beijing, China.
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Chen M, Zhang Y, Huang F, Wang H, Liu D, Li J, Rodewald L, Wu J, Deng Y, Xu W. Endemic and imported measles virus-associated outbreaks among adults, Beijing, China, 2013. Emerg Infect Dis 2015; 21:477-9. [PMID: 25695536 PMCID: PMC4344261 DOI: 10.3201/eid2103.140646] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In 2013, a resurgence of measles occurred in Beijing, China. The outbreaks occurred among adults and were associated with endemic genotype H1 and imported genotype D8 viruses. Migrant workers were disproportionately represented in the outbreaks; thus, vaccinating such workers against measles may be an effective strategy toward the elimination of this disease.
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External Quality Assessment for the Detection of Measles Virus by Reverse Transcription-PCR Using Armored RNA. PLoS One 2015; 10:e0134681. [PMID: 26244795 PMCID: PMC4526687 DOI: 10.1371/journal.pone.0134681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 07/13/2015] [Indexed: 12/13/2022] Open
Abstract
In recent years, nucleic acid tests for detection of measles virus RNA have been widely applied in laboratories belonging to the measles surveillance system of China. An external quality assessment program was established by the National Center for Clinical Laboratories to evaluate the performance of nucleic acid tests for measles virus. The external quality assessment panel, which consisted of 10 specimens, was prepared using armored RNAs, complex of noninfectious MS2 bacteriophage coat proteins encapsulated RNA of measles virus, as measles virus surrogate controls. Conserved sequences amplified from a circulating measles virus strain or from a vaccine strain were encapsulated into these armored RNAs. Forty-one participating laboratories from 15 provinces, municipalities, or autonomous regions that currently conduct molecular detection of measles virus enrolled in the external quality assessment program, including 40 measles surveillance system laboratories and one diagnostic reagent manufacturer. Forty laboratories used commercial reverse transcription-quantitative PCR kits, with only one laboratory applying a conventional PCR method developed in-house. The results indicated that most of the participants (38/41, 92.7%) were able to accurately detect the panel with 100% sensitivity and 100% specificity. Although a wide range of commercially available kits for nucleic acid extraction and reverse transcription polymerase chain reaction were used by the participants, only two false-negative results and one false-positive result were generated; these were generated by three separate laboratories. Both false-negative results were obtained with tests performed on specimens with the lowest concentration (1.2 × 104 genomic equivalents/mL). In addition, all 18 participants from Beijing achieved 100% sensitivity and 100% specificity. Overall, we conclude that the majority of the laboratories evaluated have reliable diagnostic capacities for the detection of measles virus.
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