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Kegele Lignani L, de Vasconcellos Carvalhaes de Oliveira R, Matos Dos Santos E, Antonio Bastos Camacho L, Reis Xavier J, Regina da Silva E Sá G, Mendonça Siqueira M, Marques Vieira da Silva A, Gil Melgaço J, Dos Santos Alves N, de Lourdes de Sousa Maia M, Caetano Prates Melo E. Neutralizing antibody titers against D8 genotype and persistence of measles humoral and cell-mediated immunity eight years after the first dose of measles, mumps, and rubella vaccine in Brazilian children. Vaccine 2024; 42:2065-2071. [PMID: 38413280 DOI: 10.1016/j.vaccine.2024.02.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/02/2024] [Accepted: 02/20/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Assess the level of measles vaccine-induced neutralizing antibodies against the D8 genotype and the persistence of humoral and cell-mediated immunity in children who received their first dose of the measles, mumps, and rubella vaccine eight years previously. METHODS Measles-specific IgG and neutralizing antibodies were determined in serum using ELISA and plaque reduction neutralization test, respectively. Cellular response was evaluated from peripheral blood mononuclear cells (PBMC). IFN-γ-secreting cells, memory B and T cells, and immunological mediators were assayed by ELISpot, flow cytometry, and multiplex liquid microarray assay, respectively. RESULTS Antibody concentrations declined over time; however, the vaccine-induced neutralizing antibodies' effect against D8 and vaccinal genotypes persisted. PBMC stimulated with the vaccine virus exhibited specific IFN- γ-measles-secreting responses in most participants. Participants with high levels of neutralizing antibodies showed a higher proportion of activated B cells compared to participants with low levels of neutralizing antibodies, while proportions of memory CD4+ and CD8+ T cells were similar between these groups. PBMC supernatant cytokine levels showed a significant difference between stimulated and non-stimulated conditions for IL-2, TNF-α, IL-10, and CXCL10. CONCLUSION Despite the decline in antibody concentrations over time, the participants still demonstrated neutralizing capacity against the measles D8 genotype five to eight years after the second dose of the measles, mumps, and rubella vaccine. Additionally, most of the enrolled children exhibited cell-mediated immunity responses to measles virus stimulation.
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Affiliation(s)
- Letícia Kegele Lignani
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos/Bio-Manguinhos, Avenida Brasil, 4365, Manguinhos, CEP 21041-250 Rio de Janeiro, Brazil.
| | | | - Eliane Matos Dos Santos
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos/Bio-Manguinhos, Avenida Brasil, 4365, Manguinhos, CEP 21041-250 Rio de Janeiro, Brazil
| | - Luiz Antonio Bastos Camacho
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca, Rua Leopoldo Bulhões, 1480, Manguinhos, CEP 21040-360 Rio de Janeiro, Brazil
| | - Janaína Reis Xavier
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos/Bio-Manguinhos, Avenida Brasil, 4365, Manguinhos, CEP 21041-250 Rio de Janeiro, Brazil
| | - Gloria Regina da Silva E Sá
- Universidade Federal do Estado do Rio de Janeiro, Instituto de Saúde Coletiva, Rua Professor Gabizo, 264, 3° andar, Tijuca, CEP 20271-062 Rio de Janeiro, Brazil
| | - Marilda Mendonça Siqueira
- Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Laboratório de Vírus Respiratórios, Exantemáticos, Enterovírus e Emergências Virais, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, CEP 21041-250 Rio de Janeiro, Brazil
| | - Andréa Marques Vieira da Silva
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos/Bio-Manguinhos, Avenida Brasil, 4365, Manguinhos, CEP 21041-250 Rio de Janeiro, Brazil
| | - Juliana Gil Melgaço
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos/Bio-Manguinhos, Avenida Brasil, 4365, Manguinhos, CEP 21041-250 Rio de Janeiro, Brazil
| | - Nathalia Dos Santos Alves
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos/Bio-Manguinhos, Avenida Brasil, 4365, Manguinhos, CEP 21041-250 Rio de Janeiro, Brazil
| | - Maria de Lourdes de Sousa Maia
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos/Bio-Manguinhos, Avenida Brasil, 4365, Manguinhos, CEP 21041-250 Rio de Janeiro, Brazil
| | - Enirtes Caetano Prates Melo
- Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública Sérgio Arouca, Rua Leopoldo Bulhões, 1480, Manguinhos, CEP 21040-360 Rio de Janeiro, Brazil
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González-Praetorius A, Fernández-García A, Pérez-Olmeda M, García-Rivera MV, Caballero-López B, Gilaberte-Reyzabal S, Román-Marcos E, Ory-Machón FD, Echevarría-Mayo JE. Measles outbreak in the sanitary area of Guadalajara (Spain): difficulty in microbiological diagnosis in the era of its elimination. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:532-538. [PMID: 35811250 DOI: 10.1016/j.eimce.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tolos for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). METHODS Serological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. RESULTS A total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in two that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or two vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. CONCLUSIONS The combination of molecular tests and the presence of specific IgM is necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.
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Affiliation(s)
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Centro de Investigación, Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - M Victoria García-Rivera
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, Spain
| | | | | | - Elena Román-Marcos
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, Spain
| | - Fernando de Ory-Machón
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Centro de Investigación, Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Emilio Echevarría-Mayo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain; Centro de Investigación, Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Fappani C, Gori M, Canuti M, Terraneo M, Colzani D, Tanzi E, Amendola A, Bianchi S. Breakthrough Infections: A Challenge towards Measles Elimination? Microorganisms 2022; 10:microorganisms10081567. [PMID: 36013985 PMCID: PMC9413104 DOI: 10.3390/microorganisms10081567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
Measles is one of the most contagious diseases known to man. Despite the existence of a safe and effective live attenuated vaccine, measles can appear in vaccinated individuals. Paradoxically, breakthrough cases increase as vaccination coverage in the general population rises. In measles endemic areas, breakthrough cases represent less than 10% of total infections, while in areas with high vaccination coverage these are over 10% of the total. Two different vaccination failures have been described: primary vaccination failure, which consists in the complete absence of humoral response and occurs in around 5% of vaccinated individuals; and secondary vaccination failure is due to waning immunity or incomplete immunity and occurs in 2–10% of vaccinees. Vaccination failures are generally associated with lower viral loads and milder disease (modified measles) since vaccination limits the risk of complicated disease. Vaccination failure seems to occur between six and twenty-six years after the last vaccine dose administration. This review summarizes the literature about clinical, serological, epidemiological, and molecular characteristics of measles breakthrough cases and their contribution to virus transmission. In view of the measles elimination goal, the assessment of the potential decline in antibody protection and the targeted implementation of catch-up vaccination are essential.
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Affiliation(s)
- Clara Fappani
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maria Gori
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
| | - Marta Canuti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy
| | - Mara Terraneo
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
| | - Daniela Colzani
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
| | - Elisabetta Tanzi
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
- Coordinated Research Center “EpiSoMI”, Università degli Studi di Milano, 20133 Milan, Italy
| | - Antonella Amendola
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
- Coordinated Research Center “EpiSoMI”, Università degli Studi di Milano, 20133 Milan, Italy
- Correspondence: (A.A.); (S.B.)
| | - Silvia Bianchi
- Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy
- Correspondence: (A.A.); (S.B.)
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Makarenko C, San Pedro A, Paiva NS, Santos JPCD, Medronho RDA, Gibson G. Measles resurgence in Brazil: analysis of the 2019 epidemic in the state of São Paulo. Rev Saude Publica 2022; 56:50. [PMID: 35703604 PMCID: PMC9239333 DOI: 10.11606/s1518-8787.2022056003805] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/08/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the epidemiological profile of cases and the pattern of spatial diffusion of the largest measles epidemic in Brazil that occurred in the post-elimination period in the state of São Paulo. METHOD A cross-sectional study based on confirmed measles cases in 2019. Bivariate analysis was performed for socioeconomic, clinical, and epidemiological variables, according to prior vaccination and hospitalization, combined with an analysis of spatial diffusion of cases using the Inverse Distance Weighting (IDW) method. RESULTS Of the 15,598 confirmed cases, 2,039 were hospitalized and 17 progressed to death. The epidemic peak occurred in epidemiological week 33, after confirmation of the first case, in the epidemiological week 6. Most cases were male (52.1%), aged between 18 and 29 years (38.7%), identified as whites (70%). Young adults (39.7%) and children under five years (32.8%) were the most affected age groups. A higher proportion of previous vaccination was observed in whites as compared to Blacks, browns, yellows and indigenous people (p < 0.001), as well as in the most educated group compared to the other categories (p < 0.001). The risk of hospitalization was higher in children than in the older age group (RI = 2.19; 95%CI: 1.66-2.88), as well as in the unvaccinated than in the vaccinated (RI = 1.59; 95%CI: 1.45-1.75). The pattern of diffusion by contiguity combined with diffusion by relocation followed the urban hierarchy of the main cities' regions of influence. CONCLUSION In addition to routine vaccination in children, the findings indicate the need for immunization campaigns for young adults. In addition, studies that seek to investigate the occurrence of clusters of vulnerable populations, prone to lower vaccination coverage, are essential to broaden the understanding of the dynamics of transmission and, thus, reorienting control strategies that ensure disease elimination.
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Affiliation(s)
- Cristina Makarenko
- Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | - Alexandre San Pedro
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Centro de Estudos, Políticas e Informação sobre Determinantes Sociais da Saúde. Rio de Janeiro, RJ, Brasil
| | - Natalia Santana Paiva
- Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
| | | | | | - Gerusa Gibson
- Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil
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Seok H, Españo E, Kim J, Jeon JH, Choi WS, Kim YK, Kim JK, Park DW. Immunogenicity after outbreak response immunization activities among young healthcare workers with secondary vaccine failure during the measles epidemic in Korea, 2019. BMC Infect Dis 2022; 22:530. [PMID: 35676650 DOI: 10.1186/s12879-022-07511-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite high vaccination coverage, measles outbreaks have been reported in measles elimination countries, especially among healthcare workers in their 20 and 30 s. This study was designed to identify measles-susceptible individuals and to evaluate whether primary or secondary vaccine failure occurred during measles outbreak response immunization (ORI) activities. METHODS The study population was divided into three groups as follows: natural immunity group (Group 1), vaccine-induced immunity group (Group 2), and vaccine failure group (Group 3). We evaluated the immunogenicity of measles among healthcare workers using three methods-enzyme-linked immunoassays, plaque reduction neutralization tests, and avidity assays. The results were assessed at baseline, 4 weeks after, and 6 months after the completion of measles-mumps-rubella (MMR) vaccination. RESULTS In total, 120 subjects were enrolled, with 40 subjects in each group. The median age of Group 3 was 29 years, which was significantly lower than that of the other groups. The baseline negative measles virus (MeV) IgG in Group 3 increased to a median value of 165 AU/mL at 4 weeks after ORI and was lower than that in Groups 1 and 2. The median neutralizing antibody titer was highest in Group 1, and this was significantly different from that in Group 2 or Group 3 at 4 weeks (944 vs. 405 vs. 482 mIU/mL, P = 0.001) and 6 months (826 vs. 401 vs. 470, P = 0.011) after ORI. The rates of high MeV avidity IgG were highest in Group 2, and these were significantly different from those in Groups 1 or 3 at 4 weeks (77.5 vs. 90% vs. 88.6%, P = 0.03) and 6 months (81 vs. 94.8 vs. 82.1%, P = 0.01) after ORI. CONCLUSIONS Considering the MeV-neutralizing antibodies and IgG avidity after MMR vaccination in measles-susceptible group, vaccine failure is inferred as secondary vaccine failure, and further data regarding the maintenance of immunogenicity are needed based on long-term data. The MeV-neutralizing antibody levels were highest in the natural immunity group, and the primary vaccine-induced immunity group showed the highest rates of high MeV IgG avidity.
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Navalpotro-Rodríguez D, Garay-Moya Á, Chong-Valbuena A, Melero-García M. Brote de sarampión-modificado en personal sanitario tras exposición a un caso de sarampión clásico. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Navalpotro-Rodríguez D, Garay-Moya Á, Chong-Valbuena A, Melero-Garcia M. Modified measles outbreak in vaccinated healthcare workers exposed to primary measles case. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:342-343. [PMID: 35484062 DOI: 10.1016/j.eimce.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Affiliation(s)
| | - Ángel Garay-Moya
- Servicio de Medicina Preventiva, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Servicio de Medicina Preventiva, Hospital de Sagunto, Sagunto, Valencia, Spain
| | - Andrea Chong-Valbuena
- Servicio de Medicina Preventiva, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; Sección de Epidemiología, Centro de Salud Pública de Valencia, Valencia, Spain
| | - Mercedes Melero-Garcia
- Servicio de Medicina Preventiva, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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López-Perea N, Fernández-García A, Echevarría JE, de Ory F, Pérez-Olmeda M, Masa-Calles J. Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014-2020. Viruses 2021; 13:v13101982. [PMID: 34696412 PMCID: PMC8537497 DOI: 10.3390/v13101982] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/20/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
The MMR vaccination program was introduced in Spain in 1981. Consistently high vaccination coverage has led to Spain being declared free of endemic measles transmission since 2014. A few imported and import-related cases were reported during the post-elimination phase (2014 to 2020), with very low incidence: three cases per million of inhabitants a year, 70% in adults. In the post-elimination phase an increasing proportion of measles appeared in two-dose vaccinated individuals (up to 14%), posing a challenge to surveillance and laboratory investigations. Severity and clinical presentation were milder among the vaccinated. The IgM response varied and the viral load decreased, making the virus more difficult to detect. A valid set of samples (serum, urine and throat swab) is strongly recommended for accurate case classification. One third of measles in fully vaccinated people was contracted in healthcare settings, mainly in doctors and nurses, consistent with the important role of high intensity exposure in measles breakthrough cases. Surveillance protocols and laboratory algorithms should be adapted in advanced elimination settings. Reinforcing the immunity of people working in high exposure environments, such as healthcare settings, and implementing additional infection control measures, such as masking and social distancing, are becoming crucial for the global aim of measles eradication.
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Affiliation(s)
- Noemí López-Perea
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (N.L.-P.); (J.M.-C.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
| | - Aurora Fernández-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
- Correspondence:
| | - Juan Emilio Echevarría
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
| | - Fernando de Ory
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III (ISCIII), Ctra. Majadahonda-Pozuelo s/n, 28220 Madrid, Spain;
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain
| | - Josefa Masa-Calles
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (N.L.-P.); (J.M.-C.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Av. Monforte de Lemos 5, 28029 Madrid, Spain; (J.E.E.); (F.d.O.)
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González-Praetorius A, Fernández-García A, Pérez-Olmeda M, García-Rivera MV, Caballero-López B, Gilaberte-Reyzabal S, Román-Marcos E, de Ory-Machón F, Echevarría-Mayo JE. Measles outbreak in the sanitary area of Guadalajara (Spain): Difficulty in microbiological diagnosis in the era of its elimination. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00232-9. [PMID: 34429225 DOI: 10.1016/j.eimc.2021.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/13/2021] [Accepted: 07/20/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION In Spain, like in other countries where endemic measles has been eliminated, there is a need for available diagnostic tools for confirming any cases in order to prevent and control its transmission. We describe the different microbiological tests used for the diagnosis of measles during an outbreak that occurred in 2019 in the province of Guadalajara (Spain). METHODS Serological and molecular tests were performed at the Microbiology laboratory of the Guadalajara University Hospital and at the National Center for Microbiology of the Carlos III Health Institute (Majadahonda, Spain). Patient data were obtained from the surveillance system. RESULTS A total of 43 patients had a laboratory diagnosis of measles: 29 cases by PCR (pharyngeal exudate or urine) and positive specific IgM, 11 cases by PCR, and 3 cases only by a positive IgM. Genotype D8 was identified in 35 confirmed cases and genotype A in 2 that were discarded as post-vaccination cases. PCR was positive in the acute sera of 11 out of 14 patients with a negative IgM. Eleven confirmed cases had recieved one or 2 vaccine doses. Twelve adult patients were hospitalizated, all of them with a diagnostic of hepatitis. CONCLUSIONS The combination of molecular tests and the presence of specific IgG and IgM are necessary for a correct diagnosis of measles and also to classify patients with a breakthrough infection or vaccine failures (primary or secondary). Genotyping is essential for the correct classification of the patients in the context of a measles elimination program.
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Affiliation(s)
| | - Aurora Fernández-García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Mayte Pérez-Olmeda
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España
| | - M Victoria García-Rivera
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España
| | | | | | - Elena Román-Marcos
- Servicio de Epidemiología, Dirección General de Salud Pública de Castilla-La Mancha, Toledo, España
| | - Fernando de Ory-Machón
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
| | - Juan Emilio Echevarría-Mayo
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
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Zanella B, Boccalini S, Bonito B, Del Riccio M, Tiscione E, Bonanni P, Working Group Dhs, Working Group AOUMeyer, Working Group Ausltc, Bechini A. Increasing Measles Seroprevalence in a Sample of Pediatric and Adolescent Population of Tuscany (Italy): A Vaccination Campaign Success. Vaccines (Basel) 2020; 8:E512. [PMID: 32911762 DOI: 10.3390/vaccines8030512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Despite the National Plan for the Elimination of Measles and congenital Rubella (NPEMcR), in 2017, a measles outbreak occurred in Italy, due to sub-optimal vaccination coverage (<95%) for many years. Since that year, the anti-measles vaccination became compulsory in minors (0–16 years) for school attendance. The aim of our study was to assess the immunity/susceptibility against measles in a representative sample of pediatric and adolescent (1–18 years) residents of the province of Florence (Tuscany, Italy), and to compare these results with two previous surveys (2003 and 2005–2006). Methods: The enzyme-linked immunosorbent assay (ELISA) was applied for a qualitative measurement of anti-measles antibodies on 165 sera. The anamnestic and vaccination status was also collected. Results: No measles notification was reported. The overall seropositivity was 88.5%; mostly in the 5–9 years old subjects (97.9%). Among the 152 vaccinated, 92.1% were positive. The seropositivity persisted after many years since the last dose of vaccine and tended to be more long-lasting in those who had received two or three doses. The susceptibility towards measles decreased over time, reaching a lower value in the current survey (8.5%) than in 2003 (30.8%) and in 2005–2006 (25.5%). Conclusions: This study confirmed the anti-measles vaccination campaign success, which allowed for the increase in vaccination coverage and immunity levels against measles in the Florentine pediatric and adolescent population following the NPEMcR implementation.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Masa-Calles J, López-Perea N, Godoy P. Perfil epidemiológico del sarampión en España: casos en adultos, secundarios a la importación y asociados con la asistencia sanitaria. Semergen 2020; 46:77-80. [DOI: 10.1016/j.semerg.2019.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/16/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
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López Gobernado M, Pérez-rubio A, Bachiller Luque M, Eiros Bouza J. Resurgir del sarampión: una llamada a la prevención. Semergen 2020; 46:e11-e12. [DOI: 10.1016/j.semerg.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 11/22/2022]
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Trevisan A, Bertoncello C, Artuso E, Frasson C, Lago L, Nuzzo D, Nicolli A, Maso S. Will We Have a Cohort of Healthcare Workers Full Vaccinated against Measles, Mumps, and Rubella? Vaccines (Basel) 2020; 8:E104. [PMID: 32120940 DOI: 10.3390/vaccines8010104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 02/07/2023] Open
Abstract
Healthcare workers are a population exposed to several infectious diseases, and an immunization programme is essential for the maintenance of good vaccination coverage to protect workers and patients. A population of 10,653 students attending degree courses at Padua Medical School (medicine and surgery, dentistry and health professions) was screened for vaccination coverage and antibody titres against rubella, mumps, and measles. The students were subdivided into five age classes according to their date of birth: those born before 1980, between 1980 and 1985, between 1986 and 1990, between 1991 and 1995, and after 1995. Vaccination coverage was very low in students born before 1980, but the rate of positive antibody titre was high due to infection in infancy. Increasing date of birth showed increased vaccination coverage. In contrast, immune coverage was high for rubella (more than 90%) but not for mumps and measles (approximately 80%). An “anomaly” was observed for mumps and measles in the cohort born between 1991 and 1995, probably due to the trivalent vaccine formulation. Students born after 1990 showed vaccination coverage that exceeded 90%. It is therefore very likely that we will have a future generation of healthcare workers with optimal vaccination coverage.
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Affiliation(s)
- Stanley A Plotkin
- Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia
- Vaxconsult, Doylestown, Pennsylvania
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Affiliation(s)
- Stanley A Plotkin
- Emeritus Professor of Pediatrics, University of Pennsylvania, Vaxconsult, Doylestown, Pennsylvania
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Affiliation(s)
- Josefa Masa-Calles
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III. CIBERESP, Madrid, España.
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Muñoz-Alía MÁ, Muller CP, Russell SJ. Antigenic Drift Defines a New D4 Subgenotype of Measles Virus. J Virol 2017; 91:e00209-17. [PMID: 28356529 DOI: 10.1128/JVI.00209-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 03/19/2017] [Indexed: 01/25/2023] Open
Abstract
The measles virus hemagglutinin (MeV-H) protein is the main target of protective neutralizing antibodies. Using a panel of monoclonal antibodies (MAbs) that recognize known major antigenic sites in MeV-H, we identified a D4 genotype variant that escapes neutralization by MAbs targeting the neutralizing epitope (NE) antigenic site. By site-directed mutagenesis, L249P was identified as the critical mutation disrupting the NE in this genotype D4 variant. Forty-two available D4 genotype gene sequences were subsequently analyzed and divided into 2 groups according to the presence or absence of the L249P MeV-H mutation. Further analysis of the MeV-N gene sequences of these 2 groups confirmed that they represent clearly definable, sequence-divergent D4 subgenotypes, which we named subgenotypes D4.1 and D4.2. The subgenotype D4.1 MeVs were isolated predominantly in Kenya and Ethiopia, whereas the MAb-resistant subgenotype D4.2 MeVs were isolated predominantly in France and Great Britain, countries with higher vaccine coverage rates. Interestingly, D4.2 subgenotype viruses showed a trend toward diminished susceptibility to neutralization by human sera pooled from approximately 60 to 80 North American donors. Escape from MAb neutralization may be a powerful epidemiological surveillance tool to monitor the evolution of new MeV subgenotypes.IMPORTANCE Measles virus is a paradigmatic RNA virus, as the antigenic composition of the vaccination has not needed to be updated since its discovery. The vaccine confers protection by inducing neutralizing antibodies that interfere with the function of the hemagglutinin protein. Viral strains are indistinguishable serologically, although characteristic nucleotide sequences differentiate 24 genotypes. In this work, we describe a distant evolutionary branch within genotype D4. Designated subgenotype D4.2, this virus is distinguishable by neutralization with vaccine-induced monoclonal antibodies that target the neutralizing epitope (NE). The subgenotype D4.2 viruses have a higher predominance in countries with intermediary levels of vaccine coverage. Our studies demonstrate that subgenotype D4.2 lacks epitopes associated with half of the known antigenic sites, which significantly impacts our understanding of measles virus evolution.
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