Characterisation of measles after the introduction of the combined measles-mumps-rubella (Mmr) vaccine in 2004 with focus on the laboratory data, 2016 to 2019 outbreak, Romania

Mihaela Lazar*, Aurora Stănescu, Ana Raquel Penedos, Adriana Pistol

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)

Abstract

Background: Since January 2016, a resurgence of measles in Romania has led to the third measles epidemic in the past 12 years; 64 deaths have been confirmed so far–the highest number of measles-related deaths since the measles-mumps-rubella (MMR) vaccine was introduced in 2004. Aim: To provide an overview on the characterisation on measles in Romania after the introduction of the MMR vaccine with focus on the current outbreak, laboratory and molecular analysis. Methods: We performed an analysis of measles incidence and mortality after the introduction of MMR vaccination and a retrospective study using serological and molecular data in three consecutive outbreaks with focus on the current outbreak. Results: In the current outbreak, 17,533 measles cases were notified to the national surveillance system, 93% were unvaccinated. Measles virus was isolated from 429 samples and 283 were genotyped. Genotype B3 was predominant (n = 269) and sporadic measles cases associated with D8 genotype (n = 9) were also observed; genotype D4 and D8 were identified in the previous two measles outbreaks. The detection of several distinct measles virus B3 genotypes suggests multiple virus importations to Romania. Conclusion: The current outbreak is a consequence of insufficient vaccine coverage. Control measures were implemented to improve uptake of MMR vaccine, including administering the first MMR dose at a younger age (9–11 months) and offering catch-up vaccination to children that have not followed the recommended dosing schedule. More measures are needed to improve the surveillance performance and to achieve high routine MMR vaccination coverage.

Original languageEnglish
Article number1900041
JournalEurosurveillance
Volume24
Issue number29
DOIs
Publication statusPublished - 18 Jul 2019

Bibliographical note

Funding Information:
We are very grateful to our colleagues: Radu Iuliana (INSP CRSP Bucuresti), Romana Rebreanu (INSP CRSP Cluj), Durnea Cecilia (INSP CRSP Iasi), Dana Brehar-Cioflec (CRSP Timisoara) and all our colleagues from the Romanian local public health departments for sending specimens of possible measles cases. We thank to the staff in the Viral Respiratory Infections Laboratory from Cantacuzino Insitute: Dobre Emilia, Ustea Luiza, C?t?lina Pascu, Maria Elena Mihai, Ivanciuc Alina, Carmen Cherciu and Emilia Lupulescu (who c?oord?inat?ed the natio?nal laboratory activ?it?ies by April 2?01?7) and to ?the staff fr?om Molecular Microbiology Laboratory: Sorin Dinu, Mihaela Oprea, Codruta Usein, who helped with the processing and testing of sample?s us?ed i?n ?this study. We are grateful to Kevin Brown (Public Health England, London) and Myriam Ben Mamou (Regional Laboratory Coordinator from WHO) for facilitating training at the Virus Reference Department, Public Health England, London, United Kingdom. Financial support was offered by: Ministry of Health, Ministry of Defence, Ministry of Research trough project ?Installation of National Interest? (Cerasella Dragomirescu) and ICUB (Research Institute of the University of Bucharest). Controls, part of reagents and protocols were obtained from Regional Reference Laboratory of the WHO/Europe for Measles and Rubella from Robert Koch Institute (RKI Institute), Germany, Centers for Diagnostic, Prevention and Control (CDC), Atlanta and World Health Organisation (WHO).

Funding Information:
Financial support was offered by: Ministry of Health, Ministry of Defence, Ministry of Research trough project ‘Installation of National Interest’ (Cerasella Dragomirescu) and ICUB (Research Institute of the University of Bucharest).

Publisher Copyright:
© 2019, European Centre for Disease Prevention and Control (ECDC). All rights reserved.

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