Measles outbreak linked to a minority group in Austria, 2008

SUMMARYWe report on a measles outbreak originating in an anthroposophic community in Austria, 2008. A total of 394 (94·9%) cases fulfilled the outbreak case definition including 168 cases affiliated to the anthroposophic community. The source case was a school pupil from Switzerland. The Austrian outbreak strain was genotype D5, indistinguishable from the Swiss outbreak strain. A school-based retrospective cohort study in the anthroposophic school demonstrated a vaccine effectiveness of 97·3% in pupils who had received a single dose of measles-containing vaccine and 100% in those who had received two doses. The vaccination coverage of the cases in the anthroposophic community was 0·6%. Of the 226 outbreak cases not belonging to the anthroposophic community, the 10–24 years age group was the most affected. Our findings underline the epidemiological significance of suboptimal vaccination coverage in anthroposophic communities and in older age groups of the general population in facilitating measles virus circulation. The findings of this outbreak investigation suggest that the WHO European Region is unlikely to achieve its 2010 target for measles and rubella elimination.

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Measles Outbreak in Sverdlovsk Region

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2018-17-2-50-56 ◽

2018 ◽

Vol 17 (2) ◽

pp. 50-56 ◽

Cited By ~ 2

Author(s):

S. V. Skryabina ◽

S. A. Kovyazina ◽

S. V. Kuzmin ◽

A. I. Yurovskikh ◽

O. V. Tsvirkun ◽

...

Keyword(s):

Nosocomial Infection ◽

Vaccination Coverage ◽

Measles Virus ◽

Molecular Genetic ◽

Well Being ◽

Late Diagnosis ◽

Clinical Samples ◽

Epidemiological Analysis ◽

Measles Outbreak ◽

Measles Vaccination

Objective.In the Russian Federation on the background of the sporadic incidence of measles, the trend is not highly uniform distribution of morbidity on territories of the country with the formation of local outbreaks, including the result of nosocomial infection. Find out the causes of the outbreak, for example the territory, for 15 years keeping and epidemic well-being in relation to measles, high vaccination coverage in children and adults, to assess the capacity of health care organizations and epidemiology to prevent the spread of measles and the elimination of flash was the goal of this research.Material and methods. A retrospective epidemiological analysis was held: the incidence of measles for the period 2001–2016 in the Sverdlovskiy region ; 76 «Cards epidemiological case investigation suspected measles», was from October to December 2016; the analysis of the extraordinary and final reports of the measles outbreak, reports on the activities carried out in the outbreak of measles. Laboratory verification of cases suspected were examined the ELISA method in the Perm regional centre, on the basis of detection of specific IgM and/or IgG increase. Molecular genetic research of 15 clinical specimens were performed at the Scientific- methodical centre on supervision of measles and rubella (Gabrichevsky Research Institute by Epidemiology & Microbiology», Moscow).Results.During the period c from 40 to 51 week of 2016 measles ill 76 people, mostly (66 persons) residents of the city of Yekaterinburg. Prevailed among the infected children was 67% (51 persons), usually not vaccinated against this infection – 90% (46) of children had a measles vaccination. All cases were laboratory confirmed. Expected sources or place of infection was established in 90.8% of cases. Among cases and 72.4% (55 persons) amounted to unvaccinated against measles, 11.8 per cent(9 people) were vaccinated once, of 15.8% (12) had a two-fold vaccination. In 8 hospitals was 8 foci of measles, 6 of which had spread. Among the cases of measles identified in health facilities, 35 children and 19 adults, including 5 health workers and 3 medical students. The formation of foci of nosocomial infection contributed to missed cases of measles, late diagnosis, significantly reduce the effectiveness of anti-epidemic measures. The results of molecular genetic studies of 15 clinical samples of patients selected at 42–44, and 47–49 weeks possible to establish the circulating strains of measles virus genotype D8. Epidemiological investigations and the common genetic variant circulating genotypes, selected at different stages of measles spread from different foci made it possible to combine all cases in one outbreak. Analysis of clinical manifestations of measles have testified to the fact that measles is proceeded typically in 92.2% of cases. Eleven drifts infection in educational institutions of Ekaterinburg was not accompanied by the secondary spread, indicating good collective immunity.Conclusion.Thus, a retrospective epidemiological analysis of outbreaks of measles showed that in conditions of sporadic measles in doctors reduced vigilance against measles. Late diagnosis of measles and as a consequence of its failure to carry out anti- epidemic measures led to the spread of infection, as well as skid measles in other medicine organization, which consisted of nosocomial foci. The present outbreak showed that measles requires constant attention, especially during her long absence in the region. It is only possible to prevent sustained secondary transmission if measles vaccination coverage is high for the entire population.

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Comparison of school based and supplemental vaccination strategies in the delivery of vaccines to 5-19 year olds in Africa - a systematic review

F1000Research ◽

10.12688/f1000research.12804.1 ◽

2017 ◽

Vol 6 ◽

pp. 1833 ◽

Cited By ~ 1

Author(s):

Eposi C. Haddison ◽

Leila H. Abdullahi ◽

Rudzani Muloiwa ◽

Gregory D. Hussey ◽

Benjamin M. Kagina

Keyword(s):

Systematic Review ◽

Children And Adolescents ◽

Vaccination Coverage ◽

Age Groups ◽

School Age Children ◽

School Age ◽

African Countries ◽

Routine Immunisation ◽

Public Health Burden ◽

School Based

Background: Some vaccine preventable diseases (VPDs) still remain a public health burden in many African countries. The occurrence of VPDs in all age groups has led to the realization of the need to extend routine immunisation services to school age children, adolescents and adults. Supplemental immunisation activities (SIAs) and school based vaccinations (SBVs) are common strategies used to complement the expanded programme on immunisation (EPI). This review aimed to assess the effectiveness of SIAs compared to SBVs in the administration of vaccines to 5-19 year olds in Africa. Methods: Systematic review methods were used to address our study aim. Several electronic databases were searched up to March 30, 2017 for primary studies investigating the delivery of vaccines via SIAs or SBVs to 5-19 year olds. This search was complemented by browsing reference lists of potential studies obtained from search outputs. Outcomes considered for inclusion were: vaccination coverage, costs of the strategy or its effect on routine immunisation services. Results: Out of the 4938 studies identified, 31 studies met the review inclusion criteria. Both SIAs and SBVs showed high vaccination coverage. However, the SIAs reported higher coverage than SBVs: 91% (95% CI: 84%, 98%) versus 75% (95% CI: 67%, 83%). In most settings, SBVs were reported to be more expensive than SIAs. The SIAs were found to negatively affect routine immunisation services. Conclusions: Both SIAs and SBVs are routinely used to complement the EPI in the delivery of vaccines in Africa. In settings where school enrolment is suboptimal, as is the case in many African countries, our results show SIAs may be more effective in reaching school age children and adolescents than SBVs. Our results re-iterate the importance of evaluating systematic evidence to best inform African authorities on the optimal vaccine delivery strategies targeting school age children and adolescents.

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1724. Characteristics of the Ongoing Measles Outbreak in Greece in the Context of the Recent European-wide Epidemic and Public Health Measures

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy209.130 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S54-S54

Author(s):

Theano Georgakopoulou ◽

Elina Horefti ◽

Helena Maltezou ◽

Kassiani Gkolfinopoulou ◽

Alexandra Vernardaki ◽

...

Keyword(s):

Public Health ◽

Young Adults ◽

General Population ◽

Measles Virus ◽

Case Definition ◽

Molecular Testing ◽

Mmr Vaccine ◽

Public Health Response ◽

Roma Population ◽

Measles Outbreak

Abstract Background Measles is a highly contagious disease which still remains a cause of severe complications, including deaths worldwide, despite the existence of safe and effective vaccines. In the last 3 decades, the incidence of measles in Greece has constantly declined with only sporadic clusters or outbreaks (last outbreak in 2010–2011). We describe the characteristics of the ongoing measles outbreak and the Public Health response. Methods All measles cases are reported through the mandatory notification system (EU case definition 2012) to the Department of Surveillance and Intervention of the Hellenic Centre for Disease Control and Prevention. For laboratory confirmation patient sera were tested for IgM antibodies and pharyngeal swabs for the presence of measles virus RNA with RT-PCR. Sequencing of the measles nucleoprotein gene was applied in positively tested serological samples. Results From 9 May 2017 to 26 April 2018, 2,659 cases were reported in all 13 regions in Greece; 1,605 (60.4%) were laboratory confirmed. Most cases (n = 1,595; 60%) were Roma (73% children <10 years) followed by nonminority Greek nationals (n = 781; 29.4%, of whom 57% young adults 25–44 years), highlighting the immunity gap in Roma population. The vast majority of cases (80.5%) were unvaccinated. Ninety-four (3.5%) cases were healthcare workers (HCW); all were partially or not vaccinated. Genotype B3 was identified by molecular testing in all 88 cases tested. Severe complications were reported in 429 (16.1%) patients, most frequently pneumonia (43.8%) and hepatitis (21.2%). Three deaths were recorded in an 11-month-old immunocompromised Roma infant, a 17-year-old unvaccinated Roma, and a 35 year olds partially vaccinated individual from the general population. Extensive vaccination in refugee/migrant hosting sites prevented the emergence of a large number of cases. Mitigation efforts focused on closing the immunization gap in Roma population through emergency vaccination and raising awareness among HCWs to prevent further spread. Conclusion The current outbreak highlights the need to achieve high vaccination coverage with 2 doses of MMR vaccine in the general population (children, adolescents, and young adults) and in hard-to-reach vulnerable populations like Roma and refugees. Disclosures All authors: No reported disclosures.

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Polio and Measles Down the Drain: Environmental Enterovirus Surveillance in the Netherlands, 2005 to 2015

Applied and Environmental Microbiology ◽

10.1128/aem.00558-17 ◽

2017 ◽

Vol 83 (13) ◽

Cited By ~ 13

Author(s):

Kimberley S. M. Benschop ◽

Harrie G. van der Avoort ◽

Edin Jusic ◽

Harry Vennema ◽

Rob van Binnendijk ◽

...

Keyword(s):

The Netherlands ◽

Vaccination Coverage ◽

Measles Virus ◽

Virus Detection ◽

Oral Polio Vaccine ◽

Oral Poliovirus Vaccine ◽

Content Type ◽

Polio Vaccine ◽

Virus Rna ◽

Measles Outbreak

ABSTRACT Polioviruses (PVs) are members of the genus Enterovirus. In the Netherlands, the exclusion of PV circulation is based on clinical enterovirus (EV) surveillance (CEVS) of EV-positive cases and routine environmental EV surveillance (EEVS) conducted on sewage samples collected in the region of the Netherlands where vaccination coverage is low due to religious reasons. We compared the EEVS data to those of the CEVS to gain insight into the relevance of EEVS for poliovirus and nonpolio enterovirus surveillance. Following the polio outbreak in Syria, EEVS was performed at the primary refugee center in Ter Apel in the Netherlands, and data were compared to those of CEVS and EEVS. Furthermore, we assessed the feasibility of poliovirus detection by EEVS using measles virus detection in sewage during a measles outbreak as a proxy. Two Sabin-like PVs were found in routine EEVS, 11 Sabin-like PVs were detected in the CEVS, and one Sabin-like PV was found in the Ter Apel sewage. We observed significant differences between the three programs regarding which EVs were found. In 6 sewage samples collected during the measles outbreak in 2013, measles virus RNA was detected in regions where measles cases were identified. In conclusion, we detected PVs, nonpolio EVs, and measles virus in sewage and showed that environmental surveillance is useful for poliovirus detection in the Netherlands, where live oral poliovirus vaccine is not used and communities with lower vaccination coverage exist. EEVS led to the detection of EV types not seen in the CEVS, showing that EEVS is complementary to CEVS. IMPORTANCE We show that environmental enterovirus surveillance complements clinical enterovirus surveillance for poliovirus detection, or exclusion, and for nonpolio enterovirus surveillance. Even in the presence of adequate surveillance, only a very limited number of Sabin-like poliovirus strains were detected in a 10-year period, and no signs of transmission of oral polio vaccine (OPV) strains were found in a country using exclusively inactivated polio vaccine (IPV). Measles viruses can be detected during an outbreak in sewage samples collected and concentrated following procedures used for environmental enterovirus surveillance.

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The measles outbreak in Bulgaria, 2009–2011: An epidemiological assessment and lessons learnt

Eurosurveillance ◽

10.2807/1560-7917.es.2016.21.9.30152 ◽

2016 ◽

Vol 21 (9) ◽

Cited By ~ 17

Author(s):

Mark Muscat ◽

Lili Marinova ◽

Annette Mankertz ◽

Nina Gatcheva ◽

Zafira Mihneva ◽

...

Keyword(s):

Vaccination Coverage ◽

Measles Virus ◽

National Level ◽

Control Measures ◽

Parasitic Diseases ◽

Age Group ◽

Measles Elimination ◽

National Centre ◽

Measles Outbreak ◽

Group Sex

Measles re-emerged in a nationwide outbreak in Bulgaria from 2009 to 2011 despite reported high vaccination coverage at national level. This followed an eight-year period since the last indigenous cases of measles were detected. The Bulgarian National Centre of Infectious and Parasitic Diseases collated measles surveillance data for 2009–2011. We analysed data for age group, sex, ethnicity, diagnosis confirmation, vaccination, hospitalisation, disease complications, and death and describe the outbreak control measures taken. The outbreak started in April 2009 following an importation of measles virus and affected 24,364 persons, predominantly Roma. Most cases (73%) were among children < 15 years old. Vaccination status was available for 52% (n = 12,630) of cases. Of children 1–14 years old, 22% (n = 1,769) were unvaccinated and 70% (n = 5,518) had received one dose of a measles-containing vaccine. Twenty-four measles-related deaths were reported. The Roma ethnic group was particularly susceptible to measles. The magnitude of the outbreak resulted primarily from the accumulation of susceptible children over time. This outbreak serves as a reminder that both high vaccination coverage and closing of immunity gaps across all sections of the population are crucial to reach the goal of measles elimination.

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Characteristics of the Epidemiological Situation of Measles in the Period of its Elimination in Republic of Moldova

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2019-18-4-34-40 ◽

2019 ◽

Vol 18 (4) ◽

pp. 34-40

Author(s):

A. A. Melnik ◽

V. E. Bukova ◽

L. P. Tsurcan ◽

N. I. Furtuna

Keyword(s):

Vaccination Coverage ◽

Measles Virus ◽

Age Groups ◽

Immunization Coverage ◽

Epidemiological Data ◽

Well Being ◽

Population Migration ◽

Republic Of Moldova ◽

Being There ◽

Measles Incidence

Relevance Measles continues to be one of the priorities of health care worldwide, due to it high contagiosity, still widespread, severity of the disease and complications. A high degree of population migration contributes to the spread of infection, i.e. global measles virus circulation, clinical change and late diagnosis, inadequate immunization coverage. Aim. Analysis of measles incidence in the Republic of Moldova in 2000–2018. and features of the epidemic process. Materials and Methods. Statistics on measles incidence and immunization coverage in 2000–2018 were used. 340 cases of measles registered in the country in 2018 were subjected to a detailed analysis Results There is a decrease in measles vaccination coverage, in 2017–87.1%. In the same year, the coverage with the first revaccination at 6–7 years was 92.4% and the second at 14–15 years is 94.9%, which is not enough to maintain epidemiological well-being. There are territorial differences in vaccination coverage. In 2018, imported cases of measles were in 62.5% from Ukraine, 25.0% from Russia and 12.5% from Romania. There have been isolated measles cases (14), and epidemic foci or outbreaks (7), with from 2 to 252 cases of measles. The largest measles outbreak in 2018 was registered among those who rest in a religious camp unvaccinated against measles. The average age of the diseased is 14 years, and in outbreaks with a significant number of cases (9 and more) within 7.9–14.9 years. In the age structure of the diseased, children from 1 to 10 years old prevail (66.1%), children under one year old make up 8,2%, teenagers 17,5% and adults 8.2%. Only 11.0% received one dose of measles vaccine, and 3.6% of the relevant age groups received two doses of vaccine. The reason is the refusal of vaccination for religious motive. In 196 (57.6%) cases, the diagnosis was confirmed by laboratory methods, and in the remaining 144 (42.4%) by clinical and epidemiological data. Conclusions Measles remains a childhood infection, but cases of the disease occur among adolescents (17.5%) and adults (8.2%). The uneven of vaccination coverage throughout the country, the low level of responsibility of the population, the increased incidence of measles in neighboring countries, the high level of population migration are risk factors for the importation and spread of measles.

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The importance of supplementary immunisation activities to prevent measles outbreaks during the COVID-19 pandemic in Kenya

BMC Medicine ◽

10.1186/s12916-021-01906-9 ◽

2021 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

C. N. Mburu ◽

◽

J. Ojal ◽

R. Chebet ◽

D. Akech ◽

...

Keyword(s):

Vaccination Coverage ◽

Herd Immunity ◽

African Region ◽

Population Immunity ◽

Measles Outbreak ◽

Increased Risk ◽

Measles Vaccination ◽

Serological Data ◽

Measles Outbreaks ◽

Measles Vaccination Coverage

Abstract Background The COVID-19 pandemic has disrupted routine measles immunisation and supplementary immunisation activities (SIAs) in most countries including Kenya. We assessed the risk of measles outbreaks during the pandemic in Kenya as a case study for the African Region. Methods Combining measles serological data, local contact patterns, and vaccination coverage into a cohort model, we predicted the age-adjusted population immunity in Kenya and estimated the probability of outbreaks when contact-reducing COVID-19 interventions are lifted. We considered various scenarios for reduced measles vaccination coverage from April 2020. Results In February 2020, when a scheduled SIA was postponed, population immunity was close to the herd immunity threshold and the probability of a large outbreak was 34% (8–54). As the COVID-19 contact restrictions are nearly fully eased, from December 2020, the probability of a large measles outbreak will increase to 38% (19–54), 46% (30–59), and 54% (43–64) assuming a 15%, 50%, and 100% reduction in measles vaccination coverage. By December 2021, this risk increases further to 43% (25–56), 54% (43–63), and 67% (59–72) for the same coverage scenarios respectively. However, the increased risk of a measles outbreak following the lifting of all restrictions can be overcome by conducting a SIA with ≥ 95% coverage in under-fives. Conclusion While contact restrictions sufficient for SAR-CoV-2 control temporarily reduce measles transmissibility and the risk of an outbreak from a measles immunity gap, this risk rises rapidly once these restrictions are lifted. Implementing delayed SIAs will be critical for prevention of measles outbreaks given the roll-back of contact restrictions in Kenya.

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The tip of the iceberg: incompleteness of measles reporting during a large outbreak in The Netherlands in 2013–2014

Epidemiology and Infection ◽

10.1017/s0950268818002698 ◽

2018 ◽

Vol 147 ◽

Cited By ~ 4

Author(s):

T. Woudenberg ◽

F. Woonink ◽

J. Kerkhof ◽

K. Cox ◽

W.L.M. Ruijs ◽

...

Keyword(s):

The Netherlands ◽

Vaccination Coverage ◽

National Level ◽

Notifiable Disease ◽

National Register ◽

Notifiable Diseases ◽

Measles Outbreak ◽

Large Outbreak ◽

Completeness Of Reporting

AbstractMeasles is a notifiable disease, but not everyone infected seeks care, nor is every consultation reported. We estimated the completeness of reporting during a measles outbreak in The Netherlands in 2013–2014. Children below 15 years of age in a low vaccination coverage community (n= 3422) received a questionnaire to identify measles cases. Cases found in the survey were matched with the register of notifiable diseases to estimate the completeness of reporting. Second, completeness of reporting was assessed by comparing the number of susceptible individuals prior to the outbreak with the number of reported cases in the surveyed community and on a national level.We found 307 (15%) self-identified measles cases among 2077 returned questionnaires (61%), of which 27 could be matched to a case reported to the national register; completeness of reporting was 8.8%. Based on the number of susceptible individuals and number of reported cases in the surveyed community and on national level, the completeness of reporting was estimated to be 9.1% and 8.6%, respectively. Estimating the completeness of reporting gave almost identical estimates, which lends support to the credibility and validity of both approaches. The size of the 2013–2014 outbreak approximated 31 400 measles infections.

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Different patterns of behavioural and emotional difficulties through adolescence: The influence of prosocial skills

Anales de Psicología ◽

10.6018/analesps.32.3.225031 ◽

2016 ◽

Vol 33 (1) ◽

pp. 48 ◽

Cited By ~ 3

Author(s):

Javier Ortuño-Sierra ◽

Eduardo Fonseca-Pedrero ◽

Sylvia Sastre i Riba ◽

José Muñiz

Keyword(s):

Age Groups ◽

Cluster Solution ◽

Emotional Difficulties ◽

Prosocial Skills ◽

School Based ◽

Gender And Age ◽

Behavioural Patterns ◽

Cluster Composition ◽

Strengths And Difficulties ◽

Internalizing Difficulties

The main purpose of the study was to examine the cluster composition of the analysis on the effect of gender and age of the Strengths and Difficulties Questionnaire (SDQ) in a large school-based sample of high school adolescents ranging from 14 to 18 years old (N = 1474). In order to do this, a K-means iterative cluster analysis was performed. A five-cluster solution turned out to be the most parsimonious in the differentiation of emotional and behavioural patterns. A five-cluster solution yielded the following patterns: “No difficulties and high prosocial scores” (n = 418; 28.36%), “high difficulties and low prosocial scores” (n = 239; 16.21%), “high on hyperactivity, low on the rest of the difficulties subscales, and high in prosocial capabilities” (n = 302; 20.49%), “high on emotional and peer problems, relatively low on conduct and hyperactivity, and high in prosocial capabilities” (n = 275; 18.66%), and finally “hyperactivity problems and average in the others difficulties subscales, and in prosocial capabilities” (n = 239; 16.21%). This cluster solution was replicated attending to the same gender and age groups. Nevertheless, differences in the distribution of the cluster composition suggest that difficulties differ by gender and age. The results allow for the conclusion that men reveal a greater number of problems of an externalizing nature whereas women indicate a greater degree of problems with internalizing difficulties and prosocial skills.

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Greek measles epidemic strain, 2005–2006

Epidemiology and Infection ◽

10.1017/s0950268806007308 ◽

2006 ◽

Vol 135 (4) ◽

pp. 570-573 ◽

Cited By ~ 2

Author(s):

G. GIOULA ◽

A. PAPA ◽

M. EXINDARI ◽

A. MELIDOU ◽

D. CHATZIDIMITRIOU ◽

...

Keyword(s):

Phylogenetic Tree ◽

Vaccine Strain ◽

Virus Strain ◽

Measles Virus ◽

Molecular Study ◽

N Gene ◽

Epidemic Strain ◽

Rt Pcr ◽

Measles Outbreak ◽

Genotype A

SUMMARYThe purpose of this work was the molecular study of the virus strain that caused the last measles outbreak in Greece. Twenty-four saliva specimens were obtained from selected patients serologically confirmed as measles cases between December 2005 and March 2006. Measles virus (MV) detection was performed by a nested RT–PCR. The 447-bp segment of the N gene of these MV strains was used for genotyping. The N gene sequences of the Greek MV strains were identical to each other, therefore a phylogenetic tree was constructed using one representative MV (ThesGRE/06). Our data show that the MV strain which caused the 2005–2006 outbreak in Greece belongs to genotype D6, and differs by 0·68% from the New Jersey D6 strain and by 5·5% from the MV vaccine strain Edmonston B (U03656) belonging to genotype A.

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