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Rana MS, Usman M, Ikram A, Alam MM, Salman M, Zaidi SSZ, Umair M, Stanikzai N, Shakoor A, Afghan F. Molecular identification and characterization of Measles virus genotypes circulating in Afghanistan, 2008-2018. J Med Virol 2022; 94:3448-3452. [PMID: 35261036 DOI: 10.1002/jmv.27707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/17/2022] [Accepted: 03/04/2022] [Indexed: 11/05/2022]
Abstract
The measles virus remains a leading cause of morbidity and mortality in children under five years of age. Molecular identification of circulating wild-type measles virus (MV) strains is a vital component of the measles elimination program. We received 159 oral swab samples from Afghanistan during 2008-2018. Viral RNA was extracted, followed by one-step RT-PCR and positive amplicons were subject to sequencing for genotype identification. Out of 159 total samples, 52% (83/159) were detected positive by RT-PCR. Genotype D4 was identified from 2.4% (2/83), genotype H1, 4.8% (4/83) and genotype B3, 92.7% (77/83) cases respectively. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Muhammad Suleman Rana
- Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan
| | - Muhammad Usman
- Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan
| | - Aamer Ikram
- Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan
| | - Muhammad Masroor Alam
- Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan
| | - Muhammad Salman
- Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan
| | - Syed Sohail Zahoor Zaidi
- Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan
| | - Massab Umair
- Department of Virology, National Institute of Health, Park Road, Chak Shahzad, Islamabad, Pakistan
| | | | - Abdul Shakoor
- World Health Organizations (WHO), Kabul, Afghanistan
| | - Fazel Afghan
- Central Public Health Laboratory, Kabul, Afghanistan
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2
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Kostinov MP, Zhuravlev PI, Gladkova LS, Mashilov KV, Polishchuk VB, Shmitko AD, Zorina VN, Blagovidov DA, Pahomov DV, Vlasenko AE, Ryzhov AA, Khromova EA. Comparative Analysis of the Measles Antibody Levels in Healthy Medical Personnel of Maternity Ward and Women in Labor. Front Immunol 2021; 12:680506. [PMID: 34305912 PMCID: PMC8298000 DOI: 10.3389/fimmu.2021.680506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/01/2021] [Indexed: 11/13/2022] Open
Abstract
It has been proven that post-vaccination immunity to measles virus after two doses of vaccine is not able to persistently protect against infection throughout life. The goal of this research was to determine the immune layer to the measles virus among women in labor and maternity ward personnel in the same medical institution. The levels of IgG antibodies to measles virus in the umbilical cord blood of 594 women in labor and 88 workers of the maternity ward were studied by ELISA. It was revealed that 22.7% of umbilical cord blood serum samples from parturient women and 21.4% of blood serum samples from maternity ward personnel were seronegative (<0.18 IU/ml). Levels of IgG antibodies to measles virus in low values (<1.0 IU/ml) were detected in 67% of blood serum samples among women in labor and 68.9% among employees of the maternity ward. Among women in labor, women under 35 years of age are at the highest risk of contracting measles; the proportion of women with low levels of protective antibodies in this age group was almost 70%, and the proportion of women without protective levels of antibodies was 23%. Compared with the age group 36-43, the age of women in labor under 35 was associated with a higher chance of not having immune protection against infection with measles virus OR [95% CI] = 2.2 [1.1-4.5] (p = 0.02) or had a low level of protection OR [95% CI] = 1.9 [1.2-3.0] (p = 0.001). It was also found that among women over 35 years of age, the proportion of persons with a high level of antibodies in women in labor was statistically significantly higher than among members of the maternity ward staff (13 and 0%, respectively, p = 0.007). Thus, maternity ward employees and women in labor constitute a risk group for measles due to the presence of a high proportion of seronegative persons among women of childbearing age (both maternity ward employees and women in labor). These conditions create the need to revise current approaches to present vaccination procedures, especially in the current epidemiological situation with COVID-19.
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Affiliation(s)
- Mikhail Petrovich Kostinov
- Department of Epidemiology and Modern Vaccination Technologies of I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Laboratory of Vaccine Prophylaxis and Immunotherapy of Allergic Diseases of I.I.Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - Pavel Ivanovich Zhuravlev
- Laboratory of Vaccine Prophylaxis and Immunotherapy of Allergic Diseases of I.I.Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - Lylia Solomonovna Gladkova
- City D.D. Pletnev Clinical Hospital of the Moscow City Health Department, Moscow, Russia.,Department of Epidemiology and Social Hygiene of Moscow State University of Food Industries, Moscow, Russia
| | - Kirill Vadimovich Mashilov
- Laboratory of Vaccine Prophylaxis and Immunotherapy of Allergic Diseases of I.I.Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - Valentina Borisovna Polishchuk
- Laboratory of Vaccine Prophylaxis and Immunotherapy of Allergic Diseases of I.I.Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - Anna Dmitrievna Shmitko
- Laboratory of Vaccine Prophylaxis and Immunotherapy of Allergic Diseases of I.I.Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | | | - Dmitriy Alexeyevich Blagovidov
- Laboratory of Vaccine Prophylaxis and Immunotherapy of Allergic Diseases of I.I.Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - Dmitriy Vladimirovich Pahomov
- Laboratory of Vaccine Prophylaxis and Immunotherapy of Allergic Diseases of I.I.Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - Anna Egorovna Vlasenko
- Medical Cybernetics and Informatics Department of Novokuznetsk State Institute of Advanced Training of Physicians-Branch of the "Russian Medical Academy of Continuous Professional Education" of the Ministry of Healthcare of the Russian Federation, Novokuznetsk, Russia
| | - Alexey Anatolevich Ryzhov
- Laboratory of Vaccine Prophylaxis and Immunotherapy of Allergic Diseases of I.I.Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
| | - Ekaterina Alexandrovna Khromova
- Laboratory of Vaccine Prophylaxis and Immunotherapy of Allergic Diseases of I.I.Mechnikov Research Institute of Vaccines and Sera, Moscow, Russia
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3
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Kauffmann F, Heffernan C, Meurice F, Ota MOC, Vetter V, Casabona G. Measles, mumps, rubella prevention: how can we do better? Expert Rev Vaccines 2021; 20:811-826. [PMID: 34096442 DOI: 10.1080/14760584.2021.1927722] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Measles, mumps, and rubella incidence decreased drastically following vaccination programs' implementation. However, measles and mumps' resurgence was recently reported, outbreaks still occur, and challenges remain to control these diseases. AREAS COVERED This qualitative narrative review provides an objective appraisal of the literature regarding current challenges in controlling measles, mumps, rubella infections, and interventions to address them. EXPERT OPINION While vaccines against measles, mumps, and rubella (including trivalent vaccines) are widely used and effective, challenges to control these diseases are mainly related to insufficient immunization coverage and changing vaccination needs owing to new global environment (e.g. traveling, migration, population density). By understanding disease transmission peculiarities by setting, initiatives are needed to optimize vaccination policies and increase vaccination coverage, which was further negatively impacted by COVID-19 pandemic. Also, awareness of the potential severity of infections and the role of vaccines should increase. Reminder systems, vaccination of disadvantaged, high-risk and difficult-to-reach populations, accessibility of vaccination, healthcare infrastructure, and vaccination services management should improve. Outbreak preparedness should be strengthened, including implementation of high-quality surveillance systems to monitor epidemiology. While the main focus should be on these public health initiatives to increase vaccination coverage, slightly more benefits could come from evolution of current vaccines.
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Affiliation(s)
| | - Catherine Heffernan
- NHS England (London Region), 1st Floor, Wellington House, 133-155 Waterloo Road, London, SE16UG, UK
| | - François Meurice
- GSK, Avenue Fleming 20, 1300 Wavre, Belgium.,Biomedical Sciences Department, Faculty of Medicine, University of Namur (UNamur), Rue de Bruxelles 61, 5000 Namur, Belgium
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4
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Capasso L, Lepore L, Lo Vecchio A, Caprio MG, Vallone G, Raimondi F. An Old Disease Comes Back: Reporting 2 Cases of Neonatal Measles. J Pediatric Infect Dis Soc 2021; 10:155-156. [PMID: 31603509 DOI: 10.1093/jpids/piz067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/16/2019] [Indexed: 11/13/2022]
Abstract
We report two cases of neonatal measles (one congenital and one post natal infection) admitted to our neonatal intensive care unit and discuss the management. This report intend to keep alert against measles and point out the risk for susceptible pregnant women and their offspring in countries with reduction of coverage from anti measles vaccine.
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Affiliation(s)
- Letizia Capasso
- Neonatology, Department of Translational Medical Science, and, Napoli, Italy
| | - Lorenza Lepore
- Neonatology, Department of Translational Medical Science, and, Napoli, Italy
| | - Andrea Lo Vecchio
- Pediatric Infectious Diseases Unit, Department of Translational Medical Science, and , Napoli, Italy
| | | | | | - Francesco Raimondi
- Neonatology, Department of Translational Medical Science, and, Napoli, Italy
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5
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Zhang H, Chen C, Tang A, Wu B, Liu L, Wu M, Wang H. Epidemiological Investigation and Virus Tracing of a Measles Outbreak in Zhoushan Islands, China, 2019. Front Public Health 2020; 8:600196. [PMID: 33335880 PMCID: PMC7736039 DOI: 10.3389/fpubh.2020.600196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 11/06/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Measles transmissions due to case importations challenge public health systems globally and herd immunities in all countries. In 2019, an imported measles case and its subsequently outbreak was found in the Zhoushan Islands. Here, the process of epidemiological investigation and virus tracing were summarized to provide references for the prevention and control of measles in the future. Materials and methods: The data on the demographic, epidemiological, and clinical manifestation of measles cases in this outbreak were collected. The 450 bp fragments of the measles virus (MeV) N gene were amplified and sequenced. The genome of the first imported case was further isolated. Then, the maximum-likelihood and time-scaled phylogenetic analysis was conducted. Results: A total of 28 measles cases were confirmed. Their onsets were between March 13 and May 18, 2019. The first patient was from the Ukraine. He was confirmed at the Fever Clinic in Zhoushan hospital on March 15, 2019 and at the same time, another patient had visited the hospital due to another illness and 10 days later, this second case had onset (March 25, 2019). The epidemic curve shows sustained community transmission. The majority of the following cases (19/26) were clustered on the Donggang street which was close to where the second case worked. The 22 measles virus strains successfully isolated from this outbreak all belonged to the D8.2a sub-cluster and clustered with the KY120864/MVs/GirSomnath.IND/42.16/[D8] which was the predominant genotype in the Ukraine during 2018-2019. The analysis of the complete D8 genotype genome pointed to the fact that this prevailing strain originated from India in 2015 and its substitution rate was estimated as 6.91 × 10-4 (5.64-7.98 × 10-4) nucleotide substitutions/site/year. Conclusion: This outbreak was caused by an imported case from the Ukraine. There was a possible nosocomial infection between the first case and the second case. Then, the second case played an important role in the spread of virus due to her occupation. The molecular phylogenetic analysis could help to track the origin of the virus. Increasing and maintaining the high level of vaccination coverage (≥95%) and an efficient response to imported cases are essential to prevent and control the recurrence and outbreak of measles virus.
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Affiliation(s)
- Hui Zhang
- Zhoushan Center for Disease Control and Prevention, Zhoushan, China
| | - Can Chen
- Zhoushan Center for Disease Control and Prevention, Zhoushan, China
| | - An Tang
- Zhoushan Center for Disease Control and Prevention, Zhoushan, China
| | - Bing Wu
- Zhoushan Center for Disease Control and Prevention, Zhoushan, China
| | - Leijie Liu
- Putuo Center for Disease Control and Prevention, Zhoushan, China
| | - Mingyu Wu
- Zhoushan Center for Disease Control and Prevention, Zhoushan, China
| | - Hongling Wang
- Zhoushan Center for Disease Control and Prevention, Zhoushan, China
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Baccolini V, Sindoni A, Adamo G, Rosso A, Massimi A, Bella A, Filia A, Magurano F, Marzuillo C, Villari P, De Vito C. Measles among healthcare workers in Italy: is it time to act? Hum Vaccin Immunother 2020; 16:2618-2627. [PMID: 32209017 PMCID: PMC7746257 DOI: 10.1080/21645515.2020.1737458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/27/2020] [Indexed: 12/22/2022] Open
Abstract
Vaccination of healthcare workers (HCWs) against measles is strongly recommended in Europe. In this study, we examined the impact of measles on Italian HCWs by systematically and quantitatively analyzing measles cases involving HCWs over time and by identifying the epidemiological characteristics of the respective measles outbreaks. We retrieved data on measles cases from the Italian national integrated measles and rubella surveillance system from January 2013 to May 2019. Additionally, we performed a systematic review of the literature and an analysis of the measles and rubella aggregate outbreaks reporting forms from 2014 to 2018. Our review suggests that preventing measles infection among HCWs in disease outbreaks may be crucial for the elimination of measles in Italy. National policies aiming to increase HCW immunization rates are fundamental to the protection of HCWs and patients, will limit the economic impact of outbreaks on the institutions affected and will help achieve the elimination goal.
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Affiliation(s)
- Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- Local Health Unit Roma 2, Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Fabio Magurano
- Department of Infectious Parasitic and Immune-mediated Diseases, National Institute of Health, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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7
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Spatiotemporal Distribution and Genetic Characterization of Measles Strains Circulating in Greece during the 2017-2018 Outbreak. Viruses 2020; 12:v12101166. [PMID: 33076287 PMCID: PMC7602502 DOI: 10.3390/v12101166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/08/2020] [Accepted: 10/12/2020] [Indexed: 01/16/2023] Open
Abstract
Between May 2017 and November 2018, Greece has experienced a severe measles outbreak with a total of 3258 cases reported, after reaching its goal of eliminating measles since 2014-2015. In this study, we aimed to investigate the origin and the dispersal patterns of the measles strains that circulated in Greece during this outbreak and to identify possible transmission patterns of measles virus (MeV) in the country. Of the 832 measles suspect cases referred to the National Measles and Rubella Reference Laboratory for MeV RNA detection, 131 randomly selected positive samples, representative of the temporal and spatial distribution of the laboratory-confirmed measles cases in Greece, were processed for genotypic identification by an RT-PCR amplification of a 598 bp fragment containing the 450 bp hypervariable region of the measles virus N gene. Phylogenetic analysis was carried out by the approximate maximum likelihood method (ML) under the generalized time-reversible (GTR + cat) model. All samples analyzed were found to belong to genotype B3. Comparative analysis with other European and reference measles strains revealed three separate major clusters and other multiple viruses circulating simultaneously in Greece. They were all isolated from three main community groups, Greek-Roma children, non-minority Greek nationals and immigrants/refugees, a finding that is in accordance with what was also observed in the last two measles outbreaks in 2005-2006 and 2010-2011. Notably, for one of the three clusters, no similarity was detected with previously reported prototype strains. Our results indicate the need for a more intensive vaccination program against measles amongst minority populations and in refugee hot-spots as well as the importance of molecular surveillance as a tool for monitoring measles outbreaks.
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8
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Fakhruddin M, Suandi D, Sumiati S, Fahlena H, Nuraini N, Soewono E. Investigation of a measles transmission with vaccination: a case study in Jakarta, Indonesia. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2020; 17:2998-3018. [PMID: 32987513 DOI: 10.3934/mbe.2020170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Measles is a contagious disease caused by the measles virus of genus Morbillivirus, which has been spreading in many affected regions. This infection is characterized by the appearance of rashes all over the body and potentially cause serious complications, especially among infants and children. Before measles immunization was promoted, it is one of the endemic diseases that caused the most fatalities each year in the world. This paper aims to analyze and to investigate measles transmission in Jakarta via an SIHR epidemic model involving vaccination from January to December 2017. Jakarta Health Office collected the observed data of measles incidence. We then derived the basic reproduction number as a threshold of disease transmission and obtained the local as well as global stability of the equilibria under certain conditions. The unobserved parameters and initial conditions were estimated by minimizing errors between data and numerical results. Furthermore, a stochastic model was developed to capture the data and to accommodate the randomness of the transmission. Sensitivity analysis was also performed to analyze and to identify the parameters which give significant contributions to the spread of the virus. We then obtained simulations of vaccine level coverage. The data is shown within a 95% confidence interval of the stochastic solutions, and the average of the stochastic solutions is relatively close to the solution of the deterministic model. The most sensitive parameter in the infected compartment is the hospitalized rate, which can be considered to be one of the essential factors to reduce the number of cases for policymakers. We hence proposed a control strategy which is providing treatment accesses easier for infected individuals is better than vaccinating when an outbreak occurs.
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Affiliation(s)
- Muhammad Fakhruddin
- Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Dani Suandi
- Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | | | - Hilda Fahlena
- Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Nuning Nuraini
- Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Edy Soewono
- Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Bandung 40132, Indonesia
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9
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Vaidya SR, Kasibhatla SM, Bhattad DR, Ramtirthkar MR, Kale MM, Raut CG, Kulkarni-Kale U. Characterization of diversity of measles viruses in India: Genomic sequencing and comparative genomics studies. J Infect 2020; 80:301-309. [DOI: 10.1016/j.jinf.2019.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
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10
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Measles Immunization Policies and Vaccination Coverage in EU/EEA Countries over the Last Decade. Vaccines (Basel) 2020; 8:vaccines8010086. [PMID: 32075206 PMCID: PMC7157557 DOI: 10.3390/vaccines8010086] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Starting from 2016, a major measles epidemic affected EU/EEA countries, after the measles incidence rate had progressively decreased from 2011 to 2015. METHODS This study describes measles incidences (ECDC reports), the vaccination coverages (VCs) (WHO/UNICEF reports) and the vaccination strategies, whether mandatory or recommended (ECDC Vaccine Scheduler), in 30 European countries over the last decade. RESULTS VCs were higher in countries with historically mandatory vaccination. However, in these countries, VCs declined between 2010 and 2018, in two cases to levels below 90% at the second dose. Instead, 9 and 12 countries with recommended vaccination increased their VCs, respectively, for the first and the second dose. Overall, the countries with VC ≥ 95% decreased from 20 to 15 for the first dose and from 10 to 7 for the second dose. This trend led Italy, France and Germany to make vaccination mandatory. In Italy this provision was introduced in 2017, and together with the catch-up campaigns on children between 1 and 15 years at school entry, led immediately to a strong effect: the first dose VC passed from 87% in 2016 to 93% in 2018, and from 82% to 89% for the second dose. CONCLUSIONS Mandatory vaccination is certainly a policy producing positive effects; however, it seems to require additional strategies in order to reach the WHO goal of 95% of VC. Measures such as catch-up action on susceptible populations and communication strategies aimed at increasing awareness and acceptance should be considered.
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BIANCHI S, FACCINI M, LAMBERTI A, SENATORE S, CICERI G, FRATI E, COLZANI D, GORI M, CEREDA D, GRAMEGNA M, AUXILIA F, TANZI E, AMENDOLA A. Measles surveillance activities in the Metropolitan Area of Milan during 2017-2018. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 60:E286-E292. [PMID: 31967085 PMCID: PMC6953458 DOI: 10.15167/2421-4248/jpmh2019.60.4.1269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 12/02/2019] [Indexed: 11/28/2022]
Abstract
Introduction In Italy, the transmission of measles is still endemic, and 7,919 cases were reported to the National Surveillance System between January 2017 and December 2018. Aim of this study is to report the results of the measles surveillance activities in the Metropolitan City of Milan from March 2017 to December 2018, and to evaluate the surveillance performance WHO indicators. Methods The Local Health Units (LHUs) carried out case investigations and collected specimens to send to the EpiSoMI Lab (Subnational Reference Laboratory, SRL) of the University of Milan for cases/outbreaks confirmation and genotyping performed according to the WHO Guidelines. Results Overall, 610 suspected measles cases were reported by the surveillance system of the Metropolitan City of Milan. A total of 439 out of 540 cases with adequate specimens were laboratory-confirmed by molecular and/or serological assays. Two-hundred and thirty-six cases were notified as sporadic and 203 as related to 94 outbreaks. The most confirmed cases were aged 15–39 years, almost all not vaccinated. Overall, 282 cases were genotype D8 and 118 genotype B3. The evaluation of a set of indicators to monitor the quality of surveillance activities demonstrated the proficiency of the EpiSoMI Lab. Conclusions A well-done investigation of cases and outbreaks by the surveillance local system, in a timely manner, in order to notify and investigate suspected cases and to laboratory confirm or discard cases is fundamental to reduce morbidity, to prevent further virus transmission and to achieve measles elimination.
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Affiliation(s)
- S. BIANCHI
- Department of Biomedical Sciences for Health, University of Milan, Italy
- Correspondence: Silvia Bianchi, Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal 36, 20133 Milan, Italy - Tel. +39 02 50315122 - Fax +39 02 50315120 - E-mail:
| | - M. FACCINI
- Health Protection Agency, Metropolitan Area of Milan, Italy
| | - A. LAMBERTI
- Health Protection Agency, Metropolitan Area of Milan, Italy
| | - S. SENATORE
- Health Protection Agency, Metropolitan Area of Milan, Italy
- DG Welfare, UO Prevenzione, Lombardy Region, Milan, Italy
| | - G. CICERI
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - E.R. FRATI
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - D. COLZANI
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - M. GORI
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - D. CEREDA
- DG Welfare, UO Prevenzione, Lombardy Region, Milan, Italy
| | - M. GRAMEGNA
- DG Welfare, UO Prevenzione, Lombardy Region, Milan, Italy
| | - F. AUXILIA
- Department of Biomedical Sciences for Health, University of Milan, Italy
| | - E. TANZI
- Department of Biomedical Sciences for Health, University of Milan, Italy
- Coordinated Research Center “EpiSoMI”, University of Milan, Italy
- CIRI-IV, Department of Health Sciences, University of Genoa, Italy
| | - A. AMENDOLA
- Department of Biomedical Sciences for Health, University of Milan, Italy
- Coordinated Research Center “EpiSoMI”, University of Milan, Italy
- CIRI-IV, Department of Health Sciences, University of Genoa, Italy
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12
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Adamo G, Baccolini V, Massimi A, Barbato D, Cocchiara R, Di Paolo C, Mele A, Cianfanelli S, Angelozzi A, Castellani F, Salerno C, Isonne C, Bella A, Filia A, del Manso M, Baggieri M, Nicoletti L, Magurano F, Iannazzo S, Marzuillo C, Villari P. Towards elimination of measles and rubella in Italy: Progress and challenges. PLoS One 2019; 14:e0226513. [PMID: 31841530 PMCID: PMC6913993 DOI: 10.1371/journal.pone.0226513] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/27/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION In the WHO European Region, endemic transmission of measles and rubella had been interrupted by 37 and 42 of the 53 member states (MSs), respectively, by 2018. Sixteen MSs are still endemic for measles, 11 for rubella and nine for both diseases, the latter including Italy. Elimination is documented by each country's National Verification Committee (NVC) through an annual status update (ASU). OBJECTIVE By analysing data used to produce the ASUs, we aimed to describe the advances made by Italy towards elimination of measles and rubella. Moreover, we propose a set of major interventions that could facilitate the elimination process. METHODS A total of 28 indicators were identified within the six core sections of the ASU form and these were evaluated for the period 2013-2018. These indicators relate to the incidence of measles/rubella; epidemiological investigation of cases; investigation of outbreaks; performance of the surveillance system; population immunity levels; and implementation of supplemental immunization activities (SIAs). RESULTS From 2013 to 2018, epidemiological and laboratory analyses of measles cases in Italy improved substantially, allowing timely investigation in 2017 and 2018 of most outbreak and sporadic cases and identification of the majority of genotypic variants. Moreover, since 2017, vaccination coverage has increased significantly. Despite these improvements, several areas of concern emerged, prompting the following recommendations: i) improve outbreak monitoring; ii) strengthen the MoRoNet network; iii) increase the number of SIAs; iv) reinforce vaccination services; v) maintain regional monitoring; vi) design effective communication strategies; vii) foster the role of general practitioners and family paediatricians. CONCLUSIONS The review of national ASUs is a crucial step to provide the NVC with useful insights into the elimination process and to guide the development of targeted interventions. Against this background, the seven recommendations proposed by the NVC have been shared with the Italian Ministry of Health and the Technical Advisory Group on measles and rubella elimination and have been incorporated into the new Italian Elimination Plan 2019-2023 as a technical aid to facilitate the achievement of disease elimination goals.
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Affiliation(s)
- Giovanna Adamo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
- * E-mail:
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Azzurra Massimi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Domenico Barbato
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Rosario Cocchiara
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Di Paolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Annamaria Mele
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Sara Cianfanelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Aurora Angelozzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Fulvio Castellani
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carla Salerno
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Claudia Isonne
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Antonino Bella
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Antonietta Filia
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Martina del Manso
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Melissa Baggieri
- National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Loredana Nicoletti
- National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Fabio Magurano
- National Reference Laboratory for Measles and Rubella, National Institute of Health, Rome, Italy
| | - Stefania Iannazzo
- Infectious Diseases and International Prophylaxis Office, Ministry of Health, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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Ciceri G, Canuti M, Bianchi S, Gori M, Piralla A, Colzani D, Libretti M, Frati ER, Baggieri M, Lai A, Rovida F, Zehender G, Baldanti F, Magurano F, Tanzi E, Amendola A. Genetic variability of the measles virus hemagglutinin gene in B3 genotype strains circulating in Northern Italy. INFECTION GENETICS AND EVOLUTION 2019; 75:103943. [PMID: 31255832 DOI: 10.1016/j.meegid.2019.103943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022]
Abstract
Sequencing the whole measles virus hemagglutinin (H) gene, in conjunction with a 450-nucleotide region of the nucleoprotein gene (N-450), is helpful for the identification of new genotypes and as an auxiliary in outbreak characterization. In addition, it is essential to be able to predict the antigenic changes of the H protein to gain a better monitoring of the response to the vaccine. In this study, we obtained the full-length H gene sequences from 19 measles virus (MV) strains belonging to two B3 genotype variants circulating in Lombardy (Northern Italy) between July 2015 and February 2016 and evaluated the variability of the whole MV-H gene. Furthermore, we compared the obtained H amino acid sequences to all MV sequences available in the GenBank database (n = 1152 in total) and analyzed the amino acid substitutions in the H protein within clades where the Italian strains were included. We identified a higher variability in the H gene compared to the N-450 region and our results support previous studies, highlighting that the H gene is more informative for characterizing the MV B3 genotype than the N-450 sequence. Some of the amino acid substitutions were fixed in the viral population and, remarkably, some of the amino acid substitutions were typically present only in the Italian sequences. Accumulating further molecular information about MV-H gene will be necessary to enable in-depth analyses of the variability of this gene in the vaccinated population.
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Affiliation(s)
- G Ciceri
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - M Canuti
- Department of Biology, Memorial University of Newfoundland, 232 Elizabeth Ave., St. John's, NL A1B 3X9, Canada
| | - S Bianchi
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - M Gori
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy
| | - A Piralla
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, via Taramelli, 5, 27100 Pavia, Italy.
| | - D Colzani
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - M Libretti
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy
| | - E R Frati
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy
| | - M Baggieri
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
| | - A Lai
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Section of Infectious Diseases, University of Milan, Via Gian Battista Grassi, 74, 20157 Milan, Italy.
| | - F Rovida
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, via Taramelli, 5, 27100 Pavia, Italy.
| | - G Zehender
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Section of Infectious Diseases, University of Milan, Via Gian Battista Grassi, 74, 20157 Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - F Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, via Taramelli, 5, 27100 Pavia, Italy.
| | - F Magurano
- Department of Infectious Parasitic and Immune-Mediated Diseases, National Reference Laboratory for Measles and Rubella, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161 Rome, Italy.
| | - E Tanzi
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
| | - A Amendola
- Department of Biomedical Sciences for Health, University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy; Coordinated Research Center "EpiSoMI", University of Milan, via Carlo Pascal, 36, 20133 Milan, Italy.
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