Evaluation of measles and rubella integrated surveillance system in Apulia region, Italy, 3 years after its introduction

Abstract

This study aimed at evaluating the integrated measles and rubella surveillance system (IMRSS) in Apulia region, Italy, from its introduction in 2013 to 30 June 2016. Measles and rubella case reports were extracted from IMRSS. We estimated system sensitivity at the level of case reporting, using the capture-recapture method for three data sources. Data quality was described as the completeness of variables and timeliness of notification as the median-time interval from symptoms onset to initial alert. The proportion of suspected cases with laboratory investigation, the rate of discarded cases and the origin of infection were also computed. A total of 127 measles and four rubella suspected cases were reported to IMRSS and 82 were laboratory confirmed. Focusing our analysis on measles, IMRSS sensitivity was 82% (95% CI: 75-87). Completeness was >98% for mandatory variables and 57% for 'genotyping'. The median-time interval from symptoms onset to initial alert was 4.5 days, with a timeliness of notification of 33% (41 cases reported ⩽48 h). The proportion of laboratory investigation was 87%. The rate of discarded cases was 0.1 per 100 000 inhabitants per year. The origin of infection was identified for 85% of cases. It is concluded that IMRSS provides good quality data and has good sensitivity; still efforts should be made to improve the completeness of laboratory-related variables, timeliness and to increase the rate of discarded cases.

Measles-Related Hospitalizations in Italy, 2004–2016: The Importance of High Vaccination Coverage

“…Our results showed that the hospitalization frequency significantly increased in adults aged 18–44 years over the study period, confirming an increase in susceptibility to measles that, in turn, reflected an epidemiological transition of mean age of infection towards older age groups, as expected when suboptimal vaccination coverage is maintained for a long period [1516]. These evidence are similar to those emerged by Italian study on laboratory confirmed measles cases: a case-based surveillance of measles in Sicily showed that about half of hospitalized cases were among adults aged 19 years and older, whereas a study on the evaluation of measles and rubella integrated surveillance system in Apulia region demonstrated that the age class 15–39 years was the most affected age group [1718].…”

“…This increase in susceptibility could be observed due to the fact that some adults have never been exposed to measles or have never been vaccinated; other possible reasons could be primary or secondary vaccine failures: they were vaccinated but did not respond or they suffered a decline of vaccine-induced immunity [1516171819]. It was demonstrated that having receive the last dose of measles vaccine more than 10 years previously was associated to a small but significantly increased risk of becoming infected compared with a more recent administration of the vaccine [20].…”

Prevalence and management of rubella susceptibility in healthcare workers in Italy: A systematic review and meta-analysis

“…After exclusion of duplicate articles in the two databases, there were nine eligible studies [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] ( Table 1 ), of which eight were quantitative [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] and one was qualitative [18] . The remaining 88 studies did not match the inclusion criteria [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , ...…”

Measles: Global Indicators and Progress on the road for Achieving and Sustaining Virus Eradication: A Review

“…Individuals that have contracted measles are infectious for many days after and before the inception of rash. In preliminary stage, clinical revival is just successive to rash appearance, along with resulting in viral clearance and lifelong immunity (2,5,21,37,40). As a consequence of the immunosuppression induced by measles infection, and the direct damage to the respiratory tract (loss of cilia), secondary bacterial, viral and parasitic infections may occur.…”

“…In Europe, many susceptible individuals live in communities comprising immigrants originating from countries in which there is low vaccine coverage, or in communities that choose not to be vaccinated or have restricted access to healthcare due to religious convictions; they are generally surrounded by highly vaccinated populations and therefore benefit from the herd immunity of these populations. The objective of the MDG 4 (Millennium Development Goal 4) is the reduction of overall children fatalities by 66% by 2015 as compared with stats from 1990 (36,37).…”