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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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Statler VA, Fox T, Ardura MI. Spotting a potential threat: Measles among pediatric solid organ transplantation recipients. Pediatr Transplant 2023; 27:e14502. [PMID: 36919399 DOI: 10.1111/petr.14502] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Low-vaccination rates worldwide have led to the re-emergence of vaccine-preventable infections, including measles. Immunocompromised patients, including pediatric solid organ transplant (SOT) recipients, are at risk for measles because of suboptimal vaccination, reduced or waning vaccine immunity, lifelong immunosuppression, and global re-emergence of measles. OBJECTIVES To review published cases of measles in pediatric SOT recipients to heighten awareness of its clinical manifestations, summarize diagnostic and treatment strategies, and identify opportunities to optimize prevention. METHODS We conducted a literature review of published natural measles infections in SOT recipients ≤21 years of age, summarizing management and outcomes. We describe measles epidemiology, recommended diagnostics, treatment, and highlight prevention strategies. RESULTS There are seven published reports of measles infection in 12 pediatric SOT recipients, the majority of whom were unvaccinated or incompletely vaccinated. Subjects had atypical or severe clinical presentations, including lack of rash and complications, most frequently with encephalitis and pneumonitis, resulting in 33% mortality. Updated recommendations on testing and vaccination are provided. Treatment options beyond supportive care and vitamin A are limited, with no approved antivirals. CONCLUSION While measles is infrequently reported in pediatric SOT recipients, morbidity and mortality remain significant. A high index of suspicion is warranted in susceptible SOT recipients with clinically compatible illness or exposure. Providers must recognize this risk, educate families, and be aware of both classic and atypical presentations of measles to rapidly identify, isolate, and diagnose measles in pediatric SOT recipients. Continued efforts to optimize measles vaccination both pre- and post-SOT are warranted.
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Affiliation(s)
- Victoria A Statler
- Department of Pediatrics, Pediatric Infectious Diseases, Norton Children's and University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Thomas Fox
- Department of Pediatrics, Division of Infectious Disease, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Monica I Ardura
- Department of Pediatrics, Infectious Diseases & Host Defense, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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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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Sanz JC, Ramos B, Pérez-Olmeda M, Fernández-García A. Evaluation of the detection of specific IgM against measles virus by the chemiluminescence immunoassay Liaison® Measles IgM. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:523-524. [PMID: 35729050 DOI: 10.1016/j.eimce.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/27/2021] [Accepted: 08/05/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Juan Carlos Sanz
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Belén Ramos
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, Spain
| | - Mayte Pérez-Olmeda
- Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Aurora Fernández-García
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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Sanz JC, Ramos B, Pérez-Olmeda M, Fernández-García A. Evaluación de la detección de IgM específica frente a sarampión mediante el ensayo de inmunoquimioluminiscencia Liaison® Measles IgM. Enferm Infecc Microbiol Clin 2021. [DOI: 10.1016/j.eimc.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sanz JC, Fernández-García A, Echevarría JE, de Ory F. Valuation of a commercialized RT-PCR kit for the diagnosis of infection caused by the measles virus. Enferm Infecc Microbiol Clin 2020; 39:155-156. [PMID: 32591202 DOI: 10.1016/j.eimc.2020.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Juan Carlos Sanz
- Laboratorio Regional de Salud Pública de la Comunidad de Madrid, Dirección General de Salud Pública, Consejería de Sanidad Comunidad de Madrid, Madrid, España; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), España.
| | - Aurora Fernández-García
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), España; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
| | - Juan Emilio Echevarría
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), España; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
| | - Fernando de Ory
- Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP), España; Laboratorio de Referencia e Investigación en Enfermedades Víricas Inmunoprevenibles, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, España
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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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Pergam SA, Englund JA, Kamboj M, Gans HA, Young JAH, Hill JA, Savani B, Chemaly RF, Dadwal SS, Storek J, Duchin J, Carpenter PA. Preventing Measles in Immunosuppressed Cancer and Hematopoietic Cell Transplantation Patients: A Position Statement by the American Society for Transplantation and Cellular Therapy. Biol Blood Marrow Transplant 2019; 25:e321-e330. [PMID: 31394271 DOI: 10.1016/j.bbmt.2019.07.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
Until recently, measles exposures were relatively rare and so, consequently, were an afterthought for cancer patients and/or blood and marrow transplant recipients and their providers. Declines in measles herd immunity have reached critical levels in many communities throughout the United States due to increasing vaccine hesitancy, so that community-based outbreaks have occurred. The reemergence of measles as a clinical disease has raised serious concerns among immunocompromised patients and those who work within the cancer and hematopoietic cell transplantation (HCT) community. Since live attenuated vaccines, such as measles, mumps, and rubella (MMR), are contraindicated in immunocompromised patients, and with no approved antiviral therapies for measles, community exposures in these patients can lead to life-threatening infection. The lack of data regarding measles prevention in this population poses a number of clinical dilemmas. Herein specialists in Infectious Diseases and HCT/cellular therapy endorsed by the American Society of Transplant and Cellular Therapy address frequently asked questions about measles in these high-risk cancer patients and HCT recipients and provide expert opinions based on the limited available data.
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Affiliation(s)
- Steven A Pergam
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Janet A Englund
- Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | - Mini Kamboj
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hayley A Gans
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jo-Anne H Young
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Joshua A Hill
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Bipin Savani
- Department of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanjeet S Dadwal
- Division of Infectious Diseases, City of Hope National Medical Center, Duarte, California
| | - Jan Storek
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada
| | - Jeffery Duchin
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Public Health, Seattle & King County, Seattle, Washington
| | - Paul A Carpenter
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington.
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High Concentrations of Measles Neutralizing Antibodies and High-Avidity Measles IgG Accurately Identify Measles Reinfection Cases. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2016; 23:707-16. [PMID: 27335386 PMCID: PMC4979181 DOI: 10.1128/cvi.00268-16] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/09/2016] [Indexed: 11/20/2022]
Abstract
In the United States, approximately 9% of the measles cases reported from 2012 to 2014 occurred in vaccinated individuals. Laboratory confirmation of measles in vaccinated individuals is challenging since IgM assays can give inconclusive results. Although a positive reverse transcription (RT)-PCR assay result from an appropriately timed specimen can provide confirmation, negative results may not rule out a highly suspicious case. Detection of high-avidity measles IgG in serum samples provides laboratory evidence of a past immunologic response to measles from natural infection or immunization. High concentrations of measles neutralizing antibody have been observed by plaque reduction neutralization (PRN) assays among confirmed measles cases with high-avidity IgG, referred to here as reinfection cases (RICs). In this study, we evaluated the utility of measuring levels of measles neutralizing antibody to distinguish RICs from noncases by receiver operating characteristic curve analysis. Single and paired serum samples with high-avidity measles IgG from suspected measles cases submitted to the CDC for routine surveillance were used for the analysis. The RICs were confirmed by a 4-fold rise in PRN titer or by RT-quantitative PCR (RT-qPCR) assay, while the noncases were negative by both assays. Discrimination accuracy was high with serum samples collected ≥3 days after rash onset (area under the curve, 0.953; 95% confidence interval [CI], 0.854 to 0.993). Measles neutralizing antibody concentrations of ≥40,000 mIU/ml identified RICs with 90% sensitivity (95% CI, 74 to 98%) and 100% specificity (95% CI, 82 to 100%). Therefore, when serological or RT-qPCR results are unavailable or inconclusive, suspected measles cases with high-avidity measles IgG can be confirmed as RICs by measles neutralizing antibody concentrations of ≥40,000 mIU/ml.
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Benamar T, Tajounte L, Alla A, Khebba F, Ahmed H, Mulders MN, Filali-Maltouf A, El Aouad R. Real-Time PCR for Measles Virus Detection on Clinical Specimens with Negative IgM Result in Morocco. PLoS One 2016; 11:e0147154. [PMID: 26812434 PMCID: PMC4727926 DOI: 10.1371/journal.pone.0147154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 12/28/2015] [Indexed: 01/03/2023] Open
Abstract
Since the confirmation of measles cases represents an important indicator regarding the performance of the measles-elimination program, the aim of this study was to evaluate the effectiveness of the routine procedures followed in Morocco for the laboratory confirmation of measles cases. Suspected cases reported between January 2010 and December 2012 were assessed for the timeliness of the sample collection, occurrence of measles clinical symptoms, and the results of the laboratory diagnoses. For 88% of the 2,708 suspected cases, a clinical specimen was collected within 7d of rash onset, of which 50% were IgM-positive and 2.6% were equivocal. The measles symptoms were reported in 91.4% of the cases; the occurrence of symptoms showed a positive association with the serological results (odds ratio [OR] = 2.9883, 95% confidence interval [CI] 2.2238-4.0157). Of the negative samples, 52% (n = 116) tested positive by real-time polymerase chain reaction (PCR). These results are in favor of using molecular detection to complement serological diagnosis in the context of measles surveillance approach in Morocco. In addition, the introduction of additional laboratory methods for differential diagnosis is required for the final classification of suspected cases with maculopapular rash and fever in the context of the measles elimination program.
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Affiliation(s)
- Touria Benamar
- National Institute of Hygiene, Ministry of Health, Rabat, Morocco
| | - Latifa Tajounte
- National Institute of Hygiene, Ministry of Health, Rabat, Morocco
| | - Amal Alla
- Epidemiology Department, Ministry of Health, Rabat, Morocco
| | - Fatima Khebba
- National Institute of Hygiene, Ministry of Health, Rabat, Morocco
| | - Hinda Ahmed
- Department of Communicable Disease Prevention & Control, WHO/EMRO, Cairo, Egypt
| | - Mick N. Mulders
- Expanded Programme on Immunization, World Health Organization, Geneva, Switzerland
| | - Abdelkarim Filali-Maltouf
- Microbiology and Molecular Biology Laboratory, Faculty of Sciences, University Mohammed V, Rabat, Morocco
| | - Rajae El Aouad
- School of Medicine and Pharmacy, University Mohamed V Souissi, Rabat, Morocco
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de Ory F, Minguito T, Balfagón P, Sanz JC. Comparison of chemiluminescent immunoassay and ELISA for measles IgG and IgM. APMIS 2015; 123:648-51. [DOI: 10.1111/apm.12413] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Fernando de Ory
- Laboratorio de Serología; Centro Nacional de Microbiología; Instituto de Salud Carlos III; Majadahonda Madrid Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP); Barcelona Spain
| | - Teodora Minguito
- Laboratorio de Serología; Centro Nacional de Microbiología; Instituto de Salud Carlos III; Majadahonda Madrid Spain
| | - Pilar Balfagón
- Laboratorio de Serología; Centro Nacional de Microbiología; Instituto de Salud Carlos III; Majadahonda Madrid Spain
| | - Juan C. Sanz
- CIBER de Epidemiología y Salud Pública (CIBERESP); Barcelona Spain
- Laboratorio de Salud Pública de la Comunidad de Madrid; Madrid Spain
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Suzuki S, Sato K, Watanabe H, Nezu Y, Nishimuta T. Environmental tobacco exposure is associated with vaccine modified measles in junior high school students. J Med Virol 2015; 87:1853-9. [PMID: 25959288 DOI: 10.1002/jmv.24252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/08/2022]
Abstract
Vaccine modified measles (VMM) affects individuals with attenuated vaccine induced immunity. An outbreak of measles occurred in a junior high school, starting from an unvaccinated eighth-grade student who developed natural measles and affected a majority of students who were immunized with a low potent strain of measles vaccine (TD97). To determine whether environmental tobacco smoke (ETS) exposure was associated with the development of VMM in this population, a questionnaire was used asking whether students had VMM symptoms during the outbreak and the smoking status of family members. VMM was defined in the study population as occurrence of fever and/or erythema, along with documented history of measles vaccination. A total of 513 students (85.9%) responded. Overall, the presence of in-house smokers did not differ between VMM students (49.3%) and non-VMM students (50.2%). However, in the ninth grade, presence of an in-house smoker was significantly higher in the family of VMM students (54.0%) than in non-VMM students (36.6%) (P = 0.044). Urinary cotinine levels were also measured in selected students (n = 37). Among families with at least one smoker, urinary cotinine levels were significantly higher in VMM students than in non-VMM students (P = 0.032). Furthermore, a multivariable logistic regression analysis showed that a high urinary cotinine level (>10 ng/mg creatinine; 13.5 percentile) was associated with the development of VMM. Our findings suggest that a high level of ETS exposure may be associated with an increased risk of VMM in a population with attenuated vaccine induced immunity against measles.
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Affiliation(s)
- Shuichi Suzuki
- Department of Pediatrics, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Kazuki Sato
- Department of Pediatrics, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Hiroko Watanabe
- Department of Pediatrics, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Yoko Nezu
- Department of Pediatrics, Shimoshizu National Hospital, Yotsukaido, Japan
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Olusola BA, Adeniji JA. Molecular detection of measles virus from children during a sporadic outbreak in two semi-urban areas in Nigeria. Afr J Infect Dis 2014; 8:44-9. [PMID: 25729537 PMCID: PMC4325360 DOI: 10.4314/ajid.v8i2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND According to the World Health Organization (WHO), African region accounts for 36% of deaths caused by measles worldwide. Nigeria has, over the years, recorded the highest average annual measles incidence per 100,000 populations in Africa. Measles epidemics have consistently been reported in northern Nigeria, but not in the South; reports of reduced protective haemagglutination inhibition antibody titers among children in Ibadan, southern Nigeria was made. Investigation of the viral agent responsible for the disease outbreak among children presenting with rash in two semi urban areas in southern Nigeria was carried out to confirm the etiology of the disease. METHODOLOGY Twenty six throat swabs (TS), and nineteen urine samples were collected from twenty six children residing in Onireke and Sabo areas of Ibadan following the report of an outbreak of rashes among children. Active case finding with the support of community leaders was used to locate the affected children. Multiplex reverse transcriptase polymerase chain reaction (MRT-PCR), was used to identify the agent. RESULTS 21 of the 26 children screened tested positive for measles virus, but none was positive for Rubella virus. There was significant association between measles infection, and households with higher number of persons. CONCLUSION Mass measles vaccination that targets overcrowded, rural and inaccessible areas is needed to increase herd immunity. Public health enlightenment on the benefits of vaccination is encouraged.
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Affiliation(s)
- B A Olusola
- Department of Virology, University of Ibadan, Nigeria
| | - J A Adeniji
- Department of Virology, University of Ibadan, Nigeria ; WHO National Reference Polio Laboratory, Department of Virology, University of Ibadan, Nigeria
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Martínez-Ramírez M, González-Praetorius A, Ory-Manchón FD, Martínez-Benito Y, García-Rivera MV, Hübschen J, Echevarría-Mayo JE. [Re-emergence of measles in the province of Guadalajara, Spain. Is it time to establish new strategies for its elimination?]. Enferm Infecc Microbiol Clin 2013; 32:486-90. [PMID: 24210738 DOI: 10.1016/j.eimc.2013.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 07/27/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Measles is a viral infection that was almost eradicated, but it is re-emerging in Spain and Europe in recent years. The aim of this study was to describe the microbiological, clinical and epidemiological characteristics of a measles outbreak that occurred in Guadalajara (Spain) from June to August 2012. METHODS A descriptive and retrospective study was conducted. A total of 117 samples (including serum, urine and pharyngeal swabs) from 52 patients were analyzed for measles. RESULTS Measles was diagnosed in 50 patients, 41 of them by microbiological diagnosis, and 9 by epidemiological link. The patients were grouped in four community outbreaks. No imported cases were observed. Positive IgM and positive CRP were detected in 25 patients, positive CRP only in 11 and positive IgM only in 5. The genotype D4 was identified in 13 patients and the genotype A in a post-vaccine case. The age groups most affected were adults between 20-34 years of age (38%) and younger than 15 months (26%). The large majority (86%) of patients were unvaccinated (44% Roma population, 27% younger than 15 months, 11% ideological reasons), 6% had one vaccine dose. The signs/symptoms were: rash and fever, 100%, cough, 82%, and conjunctivitis 50%. Almost one-third (32%) of patients were hospitalized, and 28% had complications. CONCLUSIONS It is very important to intensify the epidemiological surveillance of infections in the elimination phase. The increased incidence of measles was associated to unvaccinated pockets, presenting a challenge for Public Health Centers. These agencies should prepare strategies to obtain a higher vaccine coverage for the eradication of measles.
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Affiliation(s)
| | | | - Fernando de Ory-Manchón
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España
| | - Yolanda Martínez-Benito
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España
| | - M Victoria García-Rivera
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España
| | - Judith Hübschen
- Laboratorio Europeo de Referencia de Sarampión de la OMS para el sur de Europa, Centre de Recherche Public de la Santé, Luxemburgo, Luxemburgo
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Michel Y, Saloum K, Tournier C, Quinet B, Lassel L, Pérignon A, Grimprel E, Carbajal R, Vabret A, Freymuth F, Garbarg-Chenon A, Schnuriger A. Rapid molecular diagnosis of measles virus infection in an epidemic setting. J Med Virol 2013; 85:723-30. [DOI: 10.1002/jmv.23515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 01/03/2023]
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Magurano F, Fortuna C, Marchi A, Benedetti E, Bucci P, Baggieri M, Nicoletti L. Molecular epidemiology of measles virus in Italy, 2002-2007. Virol J 2012; 9:284. [PMID: 23173726 PMCID: PMC3568056 DOI: 10.1186/1743-422x-9-284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 10/30/2012] [Indexed: 11/12/2022] Open
Abstract
Background The European Regional Office of the World Health Organization (WHO/Europe) developed a strategic approach to halt the indigenous transmission of measles in its 53 Member States by 2015. In view of the goal of measles elimination, it is of great importance to assess the circulation of wild-type measles virus (MV). Genetic analysis is indispensable to understand the epidemiology of measles. Methods Urine and saliva samples were collected between May 2002 and December 2007, in order to find the origins and routes of wild type measles virus circulation. RT-PCR was performed on a total of 414 clinical samples of patients from different Italian regions. The results confirmed the genome presence in 199 samples, out of which 179 were sequenced. The sequences were genotyped by comparing the fragment coding for the carboxyl terminus of the nucleoprotein (450 nucleotides) with that one of the WHO reference strains. Results From the year 2002 to the year 2007 phylogenetic analysis of measles sequences showed a predominant circulation of the D7 genotype in the Italian territory for the years 2002–2004. This genotype was replaced by D4 and B3 genotypes in the biennium 2006–2007. During the same period C2, A, D5 and D8 genotypes were also detected. Conclusions Genetic characterization of wild-type MV provides a means to study the transmission pathways of the virus, and is an essential component of laboratory-based surveillance. Knowledge of currently circulating measles virus genotype in Italy will help in monitoring the success of the measles elimination programme and will contribute to evaluate the effectiveness of future vaccination campaigns.
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Affiliation(s)
- Fabio Magurano
- Viral Diseases and Attenuated Vaccines Unit National Institute of Health (Istituto Superiore di Sanità, ISS), Rome, Italy.
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Biron C, Beaudoux O, Ponge A, Briend-Godet V, Corne F, Tripodi D, Hazart I, Esbelin J, Biron A, Boutoille D, Raffi F. [Measles in the Nantes Teaching Hospital during the 2008-2009 epidemic]. Med Mal Infect 2011; 41:415-23. [PMID: 21703787 DOI: 10.1016/j.medmal.2010.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 08/17/2010] [Accepted: 09/30/2010] [Indexed: 12/22/2022]
Abstract
OBJECTIVE A recent measles epidemic in France incited us to report and describe measles cases requiring hospitalization, to raise the awareness of health professionals on under-diagnosis and frequent complications of this viral disease. DESIGN We carried out a retrospective and epidemiologic study of measles cases recorded in the Nantes Teaching Hospital between August 2008 and September 2009. All these cases where confirmed by biological diagnosis and recorded by the Teaching Hospital virological laboratory. RESULTS Thirteen cases of measles (11 adults and two children) were recorded during the study period. Adults were young (mean age 21.4 years); the oldest was 35 years old. We noted two severe cases with viral pneumonia and hypoxemia and one case with bacterial pneumonia. Two female patients were pregnant; one delivered prematurely, in the acute phase of measles, with no complication for the newborn. Two cases occurred in the nursing staff by documented nosocomial transmission. Sixty-nine percent of the patients were not vaccinated whereas the vaccinal status was not documented for 31%. CONCLUSIONS These cases underline the potential severity of this infection and the difficulty to diagnose measles at the early phase because of lack of awareness of medical staff. It will be necessary to reinforce prevention messages and promote measles vaccination in children as well as in young people and health workers.
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Affiliation(s)
- C Biron
- Centre de vaccinations polyvalentes, immeuble Le Tourville, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France.
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SANZ JUANCARLOS, MOSQUERA MAR, RAMOS BELÉN, RAMÍREZ ROSA, DE ORY FERNANDO, ECHEVARRIA JUANEMILIO. Assessment of RNA amplification by multiplex RT-PCR and IgM detection by indirect and capture ELISAs for the diagnosis of measles and rubella. APMIS 2010; 118:203-9. [DOI: 10.1111/j.1600-0463.2009.02581.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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De Ory F, Peña-Rey I. Sarampión en la línea de meta de la eliminación. Enferm Infecc Microbiol Clin 2010; 28:73-4. [DOI: 10.1016/j.eimc.2009.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/22/2009] [Indexed: 11/28/2022]
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Nagai M, Xin JY, Yoshida N, Miyata A, Fujino M, Ihara T, Yoshikawa T, Asano Y, Nakayama T. Modified adult measles in outbreaks in Japan, 2007-2008. J Med Virol 2009; 81:1094-101. [DOI: 10.1002/jmv.21372] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Measles risk groups in Spain: implications for the European measles-elimination target. Vaccine 2009; 27:3927-34. [PMID: 19376180 DOI: 10.1016/j.vaccine.2009.04.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 03/31/2009] [Accepted: 04/03/2009] [Indexed: 11/23/2022]
Abstract
The European Region has set itself the goal of eliminating measles by 2010. Incidence has increased in recent years. This study sought to investigate outbreaks in Spain in the period 2005-2007, in order to identify measles-vulnerable groups and compare Spain to other European countries which have also had measles outbreaks. The pattern observed for Spain proved different to that of other European countries, i.e., whereas young adults and infants aged under 15 months were affected in Spain, children aged under 9 years comprised the predominant group in other European countries. Measles cases in Spain reflect low coverage when vaccination began, a pattern that could be repeated in neighbouring countries. Vaccination efforts should thus be targeted at vulnerable groups, namely: young adults; health professionals; travelling communities; and adopted infants and foreigners from countries with important pockets of susceptibles.
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Domínguez A, Torner N, Barrabeig I, Rovira A, Rius C, Cayla J, Plasencia E, Minguell S, Sala MR, Martínez A, Costa J, Mosquera M, Cabezas C. Large outbreak of measles in a community with high vaccination coverage: implications for the vaccination schedule. Clin Infect Dis 2008; 47:1143-9. [PMID: 18823269 DOI: 10.1086/592258] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Attempts to eliminate measles from a country or region may be disrupted by an imported case that affects indigenous persons. The objective of this study was to analyze epidemiological and clinical characteristics of a measles outbreak in Catalonia, Spain, in 2006. METHODS Data on cases of measles reported to the Department of Health, Generalitat of Catalonia, during the period 28 August 2006 through 8 July 2007 were collected. Suspected cases were confirmed by determination of measles-specific immunoglobulin M antibodies and/or detection of virus genome. Incidences were calculated using the estimated population of Catalonia for 2006, and 95% confidence intervals were determined assuming a Poisson distribution. The association between proportions was determined using the chi(2) test and Fisher's exact test. The level of statistical significance was set at alpha = .05. RESULTS A total of 381 cases were confirmed, for an incidence of 6.6 cases per 100,000 persons. A total of 89.5% of cases occurred in nonvaccinated persons, mainly those aged < or =15 months (incidence, 278.2 cases per 100,000 persons; mean age of patients, 12 months). Indigenous subjects accounted for 89.8% of cases, and laboratory confirmation of results was obtained for 87.1%. Measles genotype D4 was identified in all sequenced samples. CONCLUSIONS The age distribution of cases of measles among children aged <15 months suggests that the first dose of vaccine should be routinely administered at the age of 12 months.
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Affiliation(s)
- Angela Domínguez
- Department of Public Health, University of Barcelona, Casanova 143, 08036 Barcelona, Spain.
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Hübschen JM, Kremer JR, De Landtsheer S, Muller CP. A multiplex TaqMan PCR assay for the detection of measles and rubella virus. J Virol Methods 2008; 149:246-50. [PMID: 18353451 DOI: 10.1016/j.jviromet.2008.01.032] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 01/29/2008] [Accepted: 01/31/2008] [Indexed: 10/22/2022]
Abstract
Measles and rubella virus cause fever/rash diseases that are difficult to differentiate clinically. Both viruses can be detected in the same clinical specimens and are propagated on the same cell cultures. A single-tube multiplex TaqMan assay is described for the simultaneous and rapid detection of the full spectrum of known genetic variants. The performance of the assay is similar to a conventional nested PCR and generates cDNA with random primers which can be used directly for virus genotyping.
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Affiliation(s)
- Judith M Hübschen
- Institute of Immunology and WHO Collaborative Centre for Measles and WHO European Regional Reference Laboratory for Measles and Rubella, Laboratoire National de Santé, 20A rue Auguste Lumière, L-1950 Luxembourg, Luxembourg
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Oliveira LC, Kawasato KH, Otta MS, Lima LP, Okay TS. Collection tubes with or without gel separator did not interfere with detection of rubella virus antibodies IgM and IgG. J Clin Lab Anal 2007; 21:330-4. [PMID: 17847106 PMCID: PMC6649045 DOI: 10.1002/jcla.20194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Rubella infection is an exanthematic disease, with high prevalence in the adult population. The only modality of disease that causes serious consequences is congenital rubella syndrome (CRS), which happens when a pregnant woman seronegative to rubella virus acquires the infection during early pregnancy. Due to the lack of signals and characteristic symptoms of disease, diagnosis of rubella is based essentially on laboratory tests: antibodies detection and/or virus isolation. Results of serologic tests should always be interpreted with caution, because they can be affected by the quality of blood samples, processing and storage of sera, the equipment and reagents used to perform tests, and finally by the technical expertise and training of biologists. The collection tubes with gel seem to facilitate serum separation, but on the other hand gels can retain and consequently decrease antibody titers. Therefore, we decided to investigate whether the use of collection tubes containing gel separator might interfere with rubella virus antibody detection in blood samples from children. We did not observe statistically significant differences with respect to rubella virus antibody detection (immunoglobulin M [IgM] and immunoglobulin G [IgG]) for samples collected in tubes with or without gel separator, from the two evaluated manufacturers.
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Affiliation(s)
- L C Oliveira
- LIM-36, Laboratory of Medical Investigation, Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
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de Ory F, Sanz JC, García Bermejo IM. La vacuna triple vírica: viejos virus, nuevos problemas. Enferm Infecc Microbiol Clin 2007; 25:227-9. [PMID: 17386215 DOI: 10.1157/13100461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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