Measles outbreak related to healthcare transmission

Torner, Núria; Ferràs, Joaquim; Curtò, Lorenzo; Rebull, J.; Sol, Joaquím; Costa, Josep; Mosquera, María Mar; Izquierdo, Conchita; Martı́nez, Ana; Jané, Mireia

doi:10.1016/j.vacun.2020.08.002

Cited by 3 publications

(7 citation statements)

References 22 publications

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“…Outbreaks in healthcare facilities with a growing proportion of immunized cases illustrates the importance of assessing how efficient immunity to MeV is in the long‐term. 6 , 34 , 35 , 36 …”

Section: Discussionmentioning

confidence: 99%

“…Outbreaks in healthcare facilities with a growing proportion of immunized cases illustrates the importance of assessing how efficient immunity to MeV is in the long-term. 6,[34][35][36] Vaccination is the most effective measure to prevent measles and curtail outbreaks, 37 with two doses of measles containing vaccine being ~97% effective at preventing measles and one dose ~93% effective. 5 Vaccine effectiveness observed (91%) in this outbreak cohort was at the expected level due to median age of the cohort being <18 months and, consequently, only one dose had been administered.…”

Section: Discussionmentioning

confidence: 99%

“…Such characterization will become more relevant for future guidelines in adult populations at higher risk of being infected, such as healthcare personnel with two previous doses of measles‐containing vaccine. Outbreaks in healthcare facilities with a growing proportion of immunized cases illustrates the importance of assessing how efficient immunity to MeV is in the long‐term 6,34‐36 …”

Section: Discussionmentioning

confidence: 99%

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Etiological analysis of discarded measles in the context of a measles outbreak among a highly immunized population

Torner

Mercader

Domı́nguez

et al. 2023

Pediatrics International

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Background Measles can lead to serious complications and remains an important cause of morbidity and mortality worldwide. In this study we aimed to assess the etiological diagnosis of discarded measles cases in the context of an outbreak among a highly immunized population. Methods We conducted a retrospective observational study of discarded measles cases from an outbreak that occurred from October 2006 to July 2007 in Catalonia. A confirmed case was defined as having a positive measles serum IgM result and/or a positive result by RT‐PCR in urine and/or nasopharyngeal swab; or an epidemiological link to a confirmed case. Serum specimens were tested by a commercially available indirect‐format and by an in‐house capture‐format measles IgM enzyme immunoassays. Results Testing of 89 samples discarded for measles determined the etiologies for 10 (11.2%), including one rubella, three human herpes virus 6, and six measles infections. Of 381 confirmed cases in the outbreak, 10% had received at least one dose of the measles‐mumps‐rubella vaccine versus 54% of the discarded for measles (OR: 0.09; 95% CI: 0.06, 0.14; p < 0.001). Conclusions Highly sensitive surveillance systems are critical to identifying cases, responding to outbreaks and verifying progress towards measles elimination. Molecular tools for measles detection and differential diagnosis, and collection of appropriate specimens for molecular and serological testing are essential to correctly diagnose suspected measles infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Etiological analysis of discarded measles in the context of a measles outbreak among a highly immunized population

Torner

Mercader

Domı́nguez

et al. 2023

Pediatrics International

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“…The outbreak that started in Valencia was linked to an imported case from Romania, where an active MVs/Dublin.IRL/8.16[B3]-variant measles epidemic was ongoing at that time [ 18 ]; most of the sequences identified in this outbreak were the same strain. Previous work described two transmission chains of this outbreak [ 20 , 21 ]. The outbreak investigation and the extensive contact tracing conducted by the local and regional epidemiological services in the Valencian Community and Catalonia found a clear epidemiological link between the outbreak in Valencia and the transmission chains in Castellón and Tarragona, which was then complemented by the virological and molecular study.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports suggest that infection of vaccinated individuals does not frequently result in secondary cases [ 23 , 24 , 34 , 35 ], which can be explained by the lower viral load of breakthrough infections compared with naive infections [ 21 , 34 ]. Albeit rare, secondary transmission to unvaccinated individuals has been observed in situations of intense exposure, such as within the same household [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

An interregional measles outbreak in Spain with nosocomial transmission, November 2017 to July 2018

et al. 2023

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Given sustained high vaccination coverage and enhanced surveillance for measles, Spain has been free of endemic measles transmission since 2014, achieving elimination certification from the World Health Organization in 2017. In November 2017, measles was introduced through an imported case travelling to the Valencian Community, causing an interregional outbreak. Here, we describe the outbreak using data reported to the national epidemiological surveillance network. The outbreak involved 154 cases (67 males, 87 females) notified in four regions; 148 were laboratory-confirmed and six epidemiologically linked. Most cases were adults aged 30–39 (n = 62, 40.3%) years. Sixty-two cases were hospitalised (40.3%) and 35 presented complications (22.7%). Two thirds of the cases (n = 102) were unvaccinated including 11 infants (≤ 1 year) not yet eligible for vaccination. The main route of transmission was nosocomial; at least six healthcare facilities and 41 healthcare workers and support personnel were affected. Sequencing of the viral nucleoprotein C-terminus (N450) identified genotype B3, belonging to the circulating MVs/Dublin.IRL/8.16-variant. Control measures were implemented, and the outbreak was contained in July 2018. The outbreak highlighted that raising awareness about measles and improving the vaccination coverage in under-vaccinated subgroups and personnel of healthcare facilities are key measures for prevention of future outbreaks.

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Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020

López-Perea

Fernández-García

Echevarrı́a

et al. 2021

Viruses

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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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Measles outbreak related to healthcare transmission

Cited by 3 publications

References 22 publications

Etiological analysis of discarded measles in the context of a measles outbreak among a highly immunized population

Etiological analysis of discarded measles in the context of a measles outbreak among a highly immunized population

An interregional measles outbreak in Spain with nosocomial transmission, November 2017 to July 2018

Measles in Vaccinated People: Epidemiology and Challenges in Surveillance and Diagnosis in the Post-Elimination Phase. Spain, 2014–2020

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